Provider Demographics
NPI:1144036591
Name:BERRY, DRAKE THOMAS
Entity type:Individual
Prefix:
First Name:DRAKE
Middle Name:THOMAS
Last Name:BERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 PIEDMONT AVE NE UNIT 1002
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-3341
Mailing Address - Country:US
Mailing Address - Phone:618-855-2668
Mailing Address - Fax:
Practice Address - Street 1:250 PIEDMONT AVE NE UNIT 1002
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-3341
Practice Address - Country:US
Practice Address - Phone:618-855-2668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program