Provider Demographics
NPI:1770883365
Name:SONG, BARRY D (L AC)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:D
Last Name:SONG
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5735 NANJACK CIR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-2058
Mailing Address - Country:US
Mailing Address - Phone:901-795-3900
Mailing Address - Fax:901-795-3900
Practice Address - Street 1:5735 NANJACK CIR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-2058
Practice Address - Country:US
Practice Address - Phone:901-795-3900
Practice Address - Fax:901-795-3900
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACU0000000036171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist