Provider Demographics
NPI:1801873849
Name:WADE L BARNES & JENNIFER R BURGESS
Entity type:Organization
Organization Name:WADE L BARNES & JENNIFER R BURGESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-345-4429
Mailing Address - Street 1:534 KEITH DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-6211
Mailing Address - Country:US
Mailing Address - Phone:770-345-4429
Mailing Address - Fax:770-345-4087
Practice Address - Street 1:534 KEITH DR
Practice Address - Street 2:SUITE B
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-6211
Practice Address - Country:US
Practice Address - Phone:770-345-4429
Practice Address - Fax:770-345-4087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00894176AMedicaid
GA3959320001Medicare NSC