MEDICARE: BERRIBIZI LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1588204374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERRIBIZI LLC

Provider Business Mailing Address
First Line	:	41 LENOX POINTE NE STE A
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30324-7424
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 LENOX POINTE NE STE A
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30324-7424
Country	:	US
Telephone Number	:	470-257-1947
Fax Number	:

Authorized Official
Title or Position	:	ENROLLMENT SPECIALIST
Name	:	TISA STANLEY
Credential	:
Telephone Number	:	770-284-1787

Provider Enumeration Date	:	01/09/2020
Last Update Date	:	01/09/2020

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Directions to “BERRIBIZI LLC ” Practice Location

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