Provider Demographics
NPI:1598938649
Name:JANEL SMALLMAN CARNES
Entity Type:Organization
Organization Name:JANEL SMALLMAN CARNES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:CARNES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:931-762-1155
Mailing Address - Street 1:PO BOX 652
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-0652
Mailing Address - Country:US
Mailing Address - Phone:931-762-1155
Mailing Address - Fax:931-762-1155
Practice Address - Street 1:406 E GAINES ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-3534
Practice Address - Country:US
Practice Address - Phone:931-762-1155
Practice Address - Fax:931-762-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM000279332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3351196Medicaid
TN3351196Medicaid