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General NPI Number Information
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NPI Number | 1366721706
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ENDOCRINE SPECIALISTS OF GEORGIA
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Dates
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Enumeration Date | 08/16/2011
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Last Update Date | 03/30/2012
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Provider Practice Location Address
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Address Line | 10700 MEDLOCK BRIDGE RD SUITE 102
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City | DULUTH
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State | GA
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Zip | 30097-8456
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Country | US
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Telephone | 678-691-5351
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Fax | 770-685-1241
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Provider Business Mailing Address
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Address Line | 10700 MEDLOCK BRIDGE RD SUITE 102
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City | DULUTH
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State | GA
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Zip | 30097-8456
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Country | US
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Telephone | 678-691-5351
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Fax | 770-685-1241
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL JEROME BERNARD
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Credential | MD
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Telephone | 314-374-1646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number | 60045
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License Number State | GA
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