Healthcare Provider Details

I. General information

NPI: 1285990317
Provider Name (Legal Business Name): JULIA PENDERGRAST BERRY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIA BRADFIELD PENDERGRAST NP-C

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 CENTURY BLVD NE SUITE 150
ATLANTA GA
30345-3325
US

IV. Provider business mailing address

136 MADISON AVE
DECATUR GA
30030-3540
US

V. Phone/Fax

Practice location:
  • Phone: 404-633-4595
  • Fax: 404-633-6637
Mailing address:
  • Phone: 404-313-0594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN186162
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN-NP186162
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: