Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 037479 | GA |
N | 2086X0206X | Surgical Oncologist | 037479 | GA |
NPI | 1144293119 |
---|---|
Provider Name | Dr. George Barnes JR. |
First Address | Jacksonville, FL 32256-6018 |
Second Address | Henderson, NV 89052-4170 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 21/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000564704F | (05) | GA |
E27558 | (02) |