Provider Demographics
NPI:1013562305
Name:BERG, BRIANNA SUZANNE (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:SUZANNE
Last Name:BERG
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 MONTAG CIR NE UNIT 331
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-5534
Mailing Address - Country:US
Mailing Address - Phone:208-819-9261
Mailing Address - Fax:
Practice Address - Street 1:EMORY HEALTHCARE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-8827
Practice Address - Country:US
Practice Address - Phone:208-819-9261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
GA9622363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant