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NPI Code Detail

MEDICARE: TIERRA DEE HOWARD-BERRY

MEDICARE:   TIERRA DEE HOWARD-BERRY
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
1390200000XStudent in an Organized Health Care Education/Training ProgramAT002741GA

General Provider Information

NPI Number : 1346790540
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIERRA DEE HOWARD-BERRY
Provider Business Mailing Address
First Line : 1442 BOULDERCREST RD SE
Second Line : APT G2
City : ATLANTA
State : GA
Zip : 30316-3542
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1442 BOULDERCREST RD SE
Second Line : APT G2
City : ATLANTA
State : GA
Zip : 30316-3542
Country : US
Telephone Number : 540-910-0256
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2016
Last Update Date : 10/12/2016

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Directions to “ TIERRA DEE HOWARD-BERRY ” Practice Location

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