Provider Demographics
NPI:1093225179
Name:TOLBERT BERRY, CHATORA C
Entity Type:Individual
Prefix:
First Name:CHATORA
Middle Name:C
Last Name:TOLBERT BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 CENTER ST STE 110
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-1575
Mailing Address - Country:US
Mailing Address - Phone:706-494-4300
Mailing Address - Fax:
Practice Address - Street 1:1900 10TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3605
Practice Address - Country:US
Practice Address - Phone:706-653-8556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN171176363LF0000X, 163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory