Healthcare Provider Details

I. General information

NPI: 1669588463
Provider Name (Legal Business Name): BILL G BERRYMAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 STADIUM DRIVE #140
PHENIX CITY AL
36867
US

IV. Provider business mailing address

1810 STADIUM DRIVE #140
PHENIX CITY AL
36867
US

V. Phone/Fax

Practice location:
  • Phone: 334-664-1969
  • Fax: 888-391-2191
Mailing address:
  • Phone: 334-214-4616
  • Fax: 334-214-4618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number114982
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4399
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD-070139-L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberE-3049
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number8798
License Number StateMT
# 6
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number22130
License Number StateWV
# 7
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number04-29071
License Number StateKS
# 8
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036-071941
License Number StateIL
# 9
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number058573
License Number StateGA
# 10
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME103218
License Number StateFL
# 11
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA44553
License Number StateCA
# 12
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number00026975
License Number StateAL
# 13
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number26975
License Number StateAL
# 14
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number26975
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: