Healthcare Provider Details

I. General information

NPI: 1588613194
Provider Name (Legal Business Name): ADAM ERIC BERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

1499 WALTON WAY STE 1400
AUGUSTA GA
30901-2650
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2426
  • Fax: 706-721-1138
Mailing address:
  • Phone: 706-828-8402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number057775
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number29193
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number057775
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: