Provider Demographics
NPI:1699807115
Name:GREEN, BARRY JAMES (DPH)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:JAMES
Last Name:GREEN
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 LYNCHBURG RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-3659
Mailing Address - Country:US
Mailing Address - Phone:931-967-5444
Mailing Address - Fax:877-312-2351
Practice Address - Street 1:3045 LYNCHBURG RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-3659
Practice Address - Country:US
Practice Address - Phone:931-967-5444
Practice Address - Fax:877-312-2351
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC-53021835G0303X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Not Answered183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3913864Medicare ID - Type Unspecified