Healthcare Provider Details

I. General information

NPI: 1740269760
Provider Name (Legal Business Name): GIRARD F BERRY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 BRENNER AVE VETERAN AFFAIRS, PSYCHIATRY
SALISBURY NC
28144-2515
US

IV. Provider business mailing address

1601 BRENNER AVE VETERAN AFFAIRS, PSYCHIATRY
SALISBURY NC
28144-2515
US

V. Phone/Fax

Practice location:
  • Phone: 704-638-9000
  • Fax: 336-277-9275
Mailing address:
  • Phone:
  • Fax: 336-277-9275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000100827
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: