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General NPI Number Information
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NPI Number | 1134950934
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Entity Type | Individual
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Provider Name | MARIE BERLEGE JOSEPH NP
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Gender | Female
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Dates
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Enumeration Date | 08/12/2024
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 704 BREEDLOVE DR STE A
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City | MONROE
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State | GA
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Zip | 30655-2054
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Country | US
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Telephone | 888-772-0776
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Fax | 770-751-8014
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Provider Business Mailing Address
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Address Line | 1482 SWEET BOTTOM CIR SW
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City | MARIETTA
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State | GA
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Zip | 30064-5223
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Country | US
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Telephone | 516-851-3553
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN273614
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | RN273614
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN273614
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License Number State | GA
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