Provider Demographics
NPI:1073993150
Name:ANNETTE MARY BERNARD MD P.A.
Entity Type:Organization
Organization Name:ANNETTE MARY BERNARD MD P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-414-2523
Mailing Address - Street 1:2470 WINDY HILL RD SE
Mailing Address - Street 2:NUM 366C
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8613
Mailing Address - Country:US
Mailing Address - Phone:404-414-2523
Mailing Address - Fax:404-393-8880
Practice Address - Street 1:2470 WINDY HILL RD SE
Practice Address - Street 2:NUM 366C
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8613
Practice Address - Country:US
Practice Address - Phone:404-414-2523
Practice Address - Fax:404-393-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service