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General NPI Number Information
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NPI Number | 1285990317
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Entity Type | Individual
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Provider Name | JULIA PENDERGRAST BERRY NP-C
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Gender | Female
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Dates
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Enumeration Date | 04/03/2012
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 1875 CENTURY BLVD NE SUITE 150
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City | ATLANTA
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State | GA
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Zip | 30345-3325
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Country | US
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Telephone | 404-633-4595
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Fax | 404-633-6637
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Provider Business Mailing Address
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Address Line | 136 MADISON AVE
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City | DECATUR
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State | GA
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Zip | 30030-3540
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Country | US
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Telephone | 404-313-0594
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN186162
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APRN-NP186162
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License Number State | GA
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