Basic Information
| Provider Information | |||||||||
| NPI: | 1063410173 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARNES | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3495 PIEDMONT RD NE BLDG 9 1ST FLOOR | ||||||||
| Address2: | ATTN TOBIE SHELLEY | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303051736 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 4043650966 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 777 CLEVELAND AVE SW | ||||||||
| Address2: | SUITE 604 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303157129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047686611 | ||||||||
| FaxNumber: | 4047683454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 09/16/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 041718 | GA | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 5244142 | 01 | GA | AETNA | OTHER | 1916108 | 01 | GA | UNITED HEALTHCARE | OTHER | 1063410173 | 01 | GA | BLUE CROSS BLUE SHIELD | OTHER | 331185 | 01 | GA | WELLCARE | OTHER | 000700499E | 05 | GA | MEDICAID |