Healthcare Provider Details

I. General information

NPI: 1023080561
Provider Name (Legal Business Name): ADAR BERGHOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 JOHNSON FERRY RD SUITE 300
ATLANTA GA
30342-1418
US

IV. Provider business mailing address

875 JOHNSON FERRY RD SUITE 300
ATLANTA GA
30342-1418
US

V. Phone/Fax

Practice location:
  • Phone: 404-257-9933
  • Fax: 404-257-9931
Mailing address:
  • Phone: 404-257-9933
  • Fax: 404-257-9931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD439815
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number65639
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number65638
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: