Basic Information
| Provider Information | |||||||||
| NPI: | 1376939173 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARNES | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | TANNER | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6696 US HIGHWAY 20A | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435159799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1982232424 | ||||||||
| FaxNumber: | 4198229008 | ||||||||
| Practice Location | |||||||||
| Address1: | 6696 US HIGHWAY 20A | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435159799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198223242 | ||||||||
| FaxNumber: | 4198229008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2015 | ||||||||
| LastUpdateDate: | 06/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34.013236 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.