Provider Demographics
NPI:1225546310
Name:BERGER, NATHANIEL JUSTICE
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:JUSTICE
Last Name:BERGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NATE
Other - Middle Name:
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:739 SHADOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-4616
Mailing Address - Country:US
Mailing Address - Phone:419-908-0614
Mailing Address - Fax:
Practice Address - Street 1:739 SHADOWOOD DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-4616
Practice Address - Country:US
Practice Address - Phone:419-908-0614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program