Provider Demographics
NPI:1023099983
Name:BARNES DRUG STORES OF VALDOSTA, INC
Entity type:Organization
Organization Name:BARNES DRUG STORES OF VALDOSTA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:229-245-6001
Mailing Address - Street 1:PO BOX 1187
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31603-1187
Mailing Address - Country:US
Mailing Address - Phone:229-245-6039
Mailing Address - Fax:888-276-7881
Practice Address - Street 1:200 S PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-5621
Practice Address - Country:US
Practice Address - Phone:229-245-6039
Practice Address - Fax:888-276-7881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2418332BP3500X, 332BX2000X, 333600000X, 332B00000X
3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00021645BMedicaid
GA00021645AMedicaid
FL090419800Medicaid
FL104473700Medicaid
FL105405500Medicaid
FL105405501Medicaid