Provider Demographics
NPI:1457533655
Name:BARNES, VENILLA R (DPT)
Entity Type:Individual
Prefix:MRS
First Name:VENILLA
Middle Name:R
Last Name:BARNES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:VENILLA
Other - Middle Name:R
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 COMMERCE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214
Mailing Address - Country:US
Mailing Address - Phone:404-692-1654
Mailing Address - Fax:404-393-4044
Practice Address - Street 1:105 COMMERCE DR STE B
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7352
Practice Address - Country:US
Practice Address - Phone:404-692-1654
Practice Address - Fax:404-393-4044
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205271225100000X
GAPT009550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA192951OtherBCBS PHYSICAL THERAPY
VA9521078OtherAETNA
VA1457533655Medicaid
VAP00467142OtherMEDICARE RAILROAD
VA9521078OtherAETNA
VAP00467142OtherMEDICARE RAILROAD