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General NPI Number Information
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NPI Number | 1205237393
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Entity Type | Individual
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Provider Name | ANDREA LINN MATTHES BERG DHSC, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 09/09/2014
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Last Update Date | 01/13/2020
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Provider Practice Location Address
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Address Line | 7196 SAVANNAH ST # B
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City | MOODY AFB
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State | GA
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Zip | 31699-5013
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Country | US
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Telephone | 229-257-3826
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Fax |
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Provider Business Mailing Address
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Address Line | 3880 STRATFORD CIR
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City | VALDOSTA
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State | GA
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Zip | 31605-4855
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Country | US
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Telephone | 405-248-3823
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT002630
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 308
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License Number State | OK
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