Provider Demographics
NPI:1164564910
Name:BERLINER, GARY C (MD,MPH)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:C
Last Name:BERLINER
Suffix:
Gender:M
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2395 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-5376
Mailing Address - Country:US
Mailing Address - Phone:706-265-6866
Mailing Address - Fax:706-216-8448
Practice Address - Street 1:2395 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-5376
Practice Address - Country:US
Practice Address - Phone:706-265-6866
Practice Address - Fax:706-216-8448
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041262207Q00000X, 207R00000X, 2085R0202X, 2085U0001X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Not Answered208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00961221AMedicaid
GA041262OtherLICENSE
GA041262OtherLICENSE
GAH68281Medicare UPIN