Basic Information
| Provider Information | |||||||||
| NPI: | 1629015326 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARNES | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 14883 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274154883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362746515 | ||||||||
| FaxNumber: | 3362750812 | ||||||||
| Practice Location | |||||||||
| Address1: | 1210 NEW GARDEN RD | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274102721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362946190 | ||||||||
| FaxNumber: | 3362946278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 04/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35077950 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 30863 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2191319 | 05 | OH | MEDICAID | 000000197878 | 01 | OH | ANTHEM BLUE CROSS/SHIELD | OTHER |