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General NPI Number Information
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NPI Number | 1063202745
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Entity Type | Individual
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Provider Name | GEORGETTE D BERRY
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Gender | Female
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 3107 INDIAN COTTON CIRCLE
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City | ELLENWOOD
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State | GA
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Zip | 30294
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Country | US
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Telephone | 678-275-6314
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Fax |
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Provider Business Mailing Address
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Address Line | 5966 SHERWOOD PL
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City | ELLENWOOD
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State | GA
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Zip | 30294-4089
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Country | US
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Telephone | 678-275-6314
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374K00000X
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Taxonomy Name | Religious Nonmedical Practitioner
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License Number | 0000000
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License Number State |
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