Provider Demographics
NPI:1598422214
Name:BARNETT, LEE OTIS III
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:OTIS
Last Name:BARNETT
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ROUGH LN
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-6897
Mailing Address - Country:US
Mailing Address - Phone:919-279-3999
Mailing Address - Fax:919-758-8087
Practice Address - Street 1:140 ROUGH LN
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-6897
Practice Address - Country:US
Practice Address - Phone:919-279-3999
Practice Address - Fax:919-758-8087
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X, 253Z00000X, 332U00000X, 347C00000X, 372600000X
NC9940284376J00000X, 172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver
No332U00000XSuppliersHome Delivered Meals
No347C00000XTransportation ServicesPrivate Vehicle
No372600000XNursing Service Related ProvidersAdult Companion