MEDICARE: DR. ANDREA LINN MATTHES BERG DHSC, LAT, ATC

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	2255A2300X	Athletic Trainer	AT002630	GA
2	2255A2300X	Athletic Trainer	308	OK

General Provider Information

NPI Number	:	1205237393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA LINN MATTHES BERG DHSC, LAT, ATC

Provider Business Mailing Address
First Line	:	3880 STRATFORD CIR
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31605-4855
Country	:	US
Telephone Number	:	405-248-3823
Fax Number	:

Provider Business Practice Location Address
First Line	:	7196 SAVANNAH ST # B
Second Line	:
City	:	MOODY AFB
State	:	GA
Zip	:	31699-5013
Country	:	US
Telephone Number	:	229-257-3826
Fax Number	:

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

Provider Enumeration Date	:	09/09/2014
Last Update Date	:	01/13/2020

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