=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457011223
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREGORY BERNSTEIN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2021
-----------------------------------------------------
Last Update Date | 07/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 247 S MAIN ST
-----------------------------------------------------
City | REIDSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30453-4605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-557-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8321 ROANNE DR
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32817-1219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-859-1919
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367H00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiologist Assistant
-----------------------------------------------------
License Number | AA701
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367H00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiologist Assistant
-----------------------------------------------------
License Number | 13259
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------