MEDICARE: EDWARD BERGER D.M.D.

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	1223G0001X	General Practice Dentistry	009300	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386784221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD BERGER D.M.D.

Provider Business Mailing Address
First Line	:	2970 PEACHTREE RD NW
Second Line	:	SUITE 660
City	:	ATLANTA
State	:	GA
Zip	:	30305-2192
Country	:	US
Telephone Number	:	404-237-6464
Fax Number	:	404-266-8567

Provider Business Practice Location Address
First Line	:	2970 PEACHTREE RD NW
Second Line	:	SUITE 660
City	:	ATLANTA
State	:	GA
Zip	:	30305-2115
Country	:	US
Telephone Number	:	404-237-6464
Fax Number	:	404-266-8567

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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