MEDICARE: DR. MICHAEL ALLEN BERRY M.D.

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	208600000X	Surgery Physician	T-1731	MS

General Provider Information

NPI Number	:	1790981660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ALLEN BERRY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1019
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39703-1019
Country	:	US
Telephone Number	:	662-328-1862
Fax Number	:	662-328-7597

Provider Business Practice Location Address
First Line	:	425 HOSPITAL DR STE 2
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-1938
Country	:	US
Telephone Number	:	601-984-5101
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	08/19/2024

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