MEDICARE: DANIELLE ELAINE BERRY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	080218	GA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1134523996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE ELAINE BERRY MD

Provider Business Mailing Address
First Line	:	PO BOX 52176
Second Line	:
City	:	FORT BENNING
State	:	GA
Zip	:	31995-2176
Country	:	US
Telephone Number	:	615-851-7882
Fax Number	:

Provider Business Practice Location Address
First Line	:	TREE OF LIFE HEALTHCARE
Second Line	:	1968 NORTH AVENUE
City	:	COLUMBUS
State	:	GA
Zip	:	31901
Country	:	US
Telephone Number	:	615-851-7882
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2014
Last Update Date	:	05/11/2018

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