Healthcare Provider Details

I. General information

NPI: 1134950934
Provider Name (Legal Business Name): MARIE BERLEGE JOSEPH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 BREEDLOVE DR STE A
MONROE GA
30655-2054
US

IV. Provider business mailing address

1482 SWEET BOTTOM CIR SW
MARIETTA GA
30064-5223
US

V. Phone/Fax

Practice location:
  • Phone: 888-772-0776
  • Fax: 770-751-8014
Mailing address:
  • Phone: 516-851-3553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN273614
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN273614
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN273614
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: