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General NPI Number Information
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NPI Number | 1386929222
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Entity Type | Organization
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Legal Business Name | MARC S BERGER MD PC
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Dates
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Enumeration Date | 10/11/2011
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 101 RIVERSTONE VIS STE 217
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City | BLUE RIDGE
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State | GA
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Zip | 30513-6648
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Country | US
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Telephone | 706-946-4240
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Fax | 706-946-4241
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Provider Business Mailing Address
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Address Line | 101 RIVERSTONE VIS STE 217
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City | BLUE RIDGE
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State | GA
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Zip | 30513-6648
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Country | US
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Telephone | 706-946-4240
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Fax | 706-946-4241
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARC STUART BERGER
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Credential | MD
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Telephone | 706-946-4240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 66567
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License Number State | GA
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