Healthcare Provider Details

I. General information

NPI: 1164526117
Provider Name (Legal Business Name): JOSEPH BERGER MD, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DUNWOODY PARK SUITE # 140
ATLANTA GA
30338-7404
US

IV. Provider business mailing address

1 DUNWOODY PARK SUITE # 140
ATLANTA GA
30338-7404
US

V. Phone/Fax

Practice location:
  • Phone: 770-730-8912
  • Fax: 770-390-0877
Mailing address:
  • Phone: 770-730-8912
  • Fax: 770-390-0877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number047397
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: