Provider Demographics
NPI:1770549271
Name:BARRY, FREDERICK JAMES (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:JAMES
Last Name:BARRY
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 1:1031 W MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-3498
Mailing Address - Country:US
Mailing Address - Phone:865-373-7100
Mailing Address - Fax:865-373-7101
Practice Address - Street 1:1031 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3498
Practice Address - Country:US
Practice Address - Phone:865-373-7100
Practice Address - Fax:865-373-7101
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-030947B207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ065403Medicaid
OH2296359Medicaid
OH4093761Medicare ID - Type Unspecified