Provider Demographics
NPI:1174884233
Name:BARNES, T ELLIS IV (MD)
Entity type:Individual
Prefix:DR
First Name:T
Middle Name:ELLIS
Last Name:BARNES
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 919
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-0919
Mailing Address - Country:US
Mailing Address - Phone:912-826-4057
Mailing Address - Fax:912-826-2853
Practice Address - Street 1:5354 REYNOLDS STREET
Practice Address - Street 2:STE #202
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405
Practice Address - Country:US
Practice Address - Phone:912-352-0920
Practice Address - Fax:912-826-2853
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA81556208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003212562AMedicaid