Healthcare Provider Details

I. General information

NPI: 1043217458
Provider Name (Legal Business Name): JERRY E BERLAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5995 BARFIELD RD
SANDY SPRINGS GA
30328-4411
US

IV. Provider business mailing address

5901A PEACHTREE DUNWOODY RD NE STE 500
ATLANTA GA
30328-5382
US

V. Phone/Fax

Practice location:
  • Phone: 404-256-1507
  • Fax: 404-250-0440
Mailing address:
  • Phone: 404-256-1507
  • Fax: 404-250-0440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number045397
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: