Provider Demographics
NPI:1144201781
Name:BERNER, JASON ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ANDREW
Last Name:BERNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:220 J L WHITE DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-4893
Mailing Address - Country:US
Mailing Address - Phone:706-253-3842
Mailing Address - Fax:706-253-3837
Practice Address - Street 1:220 J L WHITE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4893
Practice Address - Country:US
Practice Address - Phone:706-253-3842
Practice Address - Fax:706-253-3837
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA048322207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA029441OtherBCBS
GAP00348390OtherRAILROAD MEDICARE
H89461Medicare UPIN
GAP00348390OtherRAILROAD MEDICARE