Provider Demographics
NPI:1386096402
Name:BARRY, DONNA
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:BARRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 SHAW DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-5041
Mailing Address - Country:US
Mailing Address - Phone:240-243-3490
Mailing Address - Fax:202-974-6966
Practice Address - Street 1:871 SHAW DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-5041
Practice Address - Country:US
Practice Address - Phone:240-243-3490
Practice Address - Fax:240-243-3490
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies