Healthcare Provider Details

I. General information

NPI: 1649270885
Provider Name (Legal Business Name): JORDAN H. BERNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6095 BARFIELD RD NE SUITE 200
ATLANTA GA
30328-4408
US

IV. Provider business mailing address

6095 BARFIELD RD NE SUITE 200
ATLANTA GA
30328-4408
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-1766
  • Fax: 404-851-1767
Mailing address:
  • Phone: 404-851-1766
  • Fax: 404-851-1767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number047399
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: