Provider Demographics
NPI:1588750913
Name:BARRETT, GEORGE BALLOU (ATC)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:BALLOU
Last Name:BARRETT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 BEN GAMBLE RD
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-5217
Mailing Address - Country:US
Mailing Address - Phone:423-737-2907
Mailing Address - Fax:423-753-1167
Practice Address - Street 1:684 OLD STATE ROUTE 34
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-6094
Practice Address - Country:US
Practice Address - Phone:423-753-1150
Practice Address - Fax:423-753-1167
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000004962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer