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General NPI Number Information
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NPI Number | 1275146060
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Entity Type | Individual
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Provider Name | ERICA J BERRY PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/31/2020
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 1910 BLANDING ST
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City | COLUMBIA
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State | SC
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Zip | 29201-3500
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Country | US
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Telephone | 803-256-4107
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Fax |
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Provider Business Mailing Address
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Address Line | 2170 N LAKE DR APT 7012
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City | COLUMBIA
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State | SC
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Zip | 29212-8128
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Country | US
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Telephone | 803-447-7199
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4833
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License Number State | SC
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