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General NPI Number Information
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NPI Number | 1508188558
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Entity Type | Organization
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Legal Business Name | GEORGIA MOUNTAIN ENDOCRINOLOGY CORPORATION
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Dates
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Enumeration Date | 02/18/2010
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Last Update Date | 02/18/2010
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Provider Practice Location Address
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Address Line | 120 OAKSIDE CT SUITE H
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City | CANTON
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State | GA
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Zip | 30114-2471
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Country | US
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Telephone | 404-556-9696
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Fax |
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Provider Business Mailing Address
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Address Line | 120 OAKSIDE CT SUITE H
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City | CANTON
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State | GA
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Zip | 30114-2471
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Country | US
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Telephone | 404-556-9696
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JASON BERNER
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Credential | MD
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Telephone | 404-556-9696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 048322
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License Number State | GA
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