Provider Demographics
NPI:1982655841
Name:BARRON, FREDDIE THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:FREDDIE
Middle Name:THOMAS
Last Name:BARRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7730 DANNAHER DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-4039
Mailing Address - Country:US
Mailing Address - Phone:865-524-7107
Mailing Address - Fax:865-524-3709
Practice Address - Street 1:7730 DANNAHER DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-4039
Practice Address - Country:US
Practice Address - Phone:865-524-7107
Practice Address - Fax:865-524-3709
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000009880208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2001399OtherBLUE CROSS BLUE SHIELD
TN3005824Medicaid
TNA97056Medicare UPIN
TN3005824Medicaid