Provider Demographics
NPI:1063410173
Name:BARNES, ANTHONY EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:EDWARD
Last Name:BARNES
Suffix:
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 1:3495 PIEDMONT RD NE BLDG 9 1ST FLOOR
Mailing Address - Street 2:ATTN TOBIE SHELLEY
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1736
Mailing Address - Country:UM
Mailing Address - Phone:404-365-0966
Mailing Address - Fax:
Practice Address - Street 1:777 CLEVELAND AVE SW
Practice Address - Street 2:SUITE 604
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-7129
Practice Address - Country:US
Practice Address - Phone:404-768-6611
Practice Address - Fax:404-768-3454
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041718208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5244142OtherAETNA
GA1916108OtherUNITED HEALTHCARE
GA1063410173OtherBLUE CROSS BLUE SHIELD
GA331185OtherWELLCARE
GA000700499EMedicaid
GA000700499EMedicaid
GA34BDFGHMedicare PIN