MEDICARE: DR. PAUL JEROME BERNARD 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	2080P0205X	Pediatric Endocrinology Physician	2007015922	MO
2	2080P0205X	Pediatric Endocrinology Physician	060045	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	:	1891990743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL JEROME BERNARD MD

Provider Business Mailing Address
First Line	:	10700 MEDLOCK BRIDGE RD
Second Line	:	SUITE 102
City	:	DULUTH
State	:	GA
Zip	:	30097-8456
Country	:	US
Telephone Number	:	678-691-5351
Fax Number	:	770-685-1241

Provider Business Practice Location Address
First Line	:	10700 MEDLOCK BRIDGE RD
Second Line	:	SUITE 102
City	:	DULUTH
State	:	GA
Zip	:	30097-8456
Country	:	US
Telephone Number	:	678-691-5351
Fax Number	:	770-685-1241

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

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	10/28/2011

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