Provider Demographics
NPI:1699731240
Name:BARNES, TIMOTHY A (PA-C/SA)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:A
Last Name:BARNES
Suffix:
Gender:M
Credentials:PA-C/SA
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 1380
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202
Mailing Address - Country:US
Mailing Address - Phone:256-235-5860
Mailing Address - Fax:256-235-5190
Practice Address - Street 1:901 LEIGHTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207
Practice Address - Country:US
Practice Address - Phone:256-236-1300
Practice Address - Fax:256-236-0254
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-4363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000042316Medicare PIN