Provider Demographics
NPI:1770869042
Name:BARNETT, JONATHAN BAILEY I
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:BAILEY
Last Name:BARNETT
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9523 THORNBERRY DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-8208
Mailing Address - Country:US
Mailing Address - Phone:423-413-4519
Mailing Address - Fax:
Practice Address - Street 1:5032 OOLTEWAH RINGGOLD RD
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-7091
Practice Address - Country:US
Practice Address - Phone:423-396-6963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN203121023Medicaid