Healthcare Provider Details

I. General information

NPI: 1205801008
Provider Name (Legal Business Name): CARLA MARIE BERGER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N DAVIS DR
WARNER ROBINS GA
31093-3348
US

IV. Provider business mailing address

PO BOX 2866
WARNER ROBINS GA
31099-2866
US

V. Phone/Fax

Practice location:
  • Phone: 478-464-5228
  • Fax:
Mailing address:
  • Phone: 478-464-5228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number088205
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: