Healthcare Provider Details

I. General information

NPI: 1679555924
Provider Name (Legal Business Name): PATRICIA E BERGEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 JOHNSON FERRY RD NE SUITE 500
ATLANTA GA
30342-1619
US

IV. Provider business mailing address

975 JOHNSON FERRY RD NE SUITE 500
ATLANTA GA
30342-1619
US

V. Phone/Fax

Practice location:
  • Phone: 404-256-1311
  • Fax: 404-250-3380
Mailing address:
  • Phone: 404-256-1311
  • Fax: 404-250-3380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number002014
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: