Provider Demographics
NPI:1235166547
Name:BERGER, JAY STEVEN (MD)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:STEVEN
Last Name:BERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:58 HOSPITAL ROAD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263
Mailing Address - Country:US
Mailing Address - Phone:770-253-9900
Mailing Address - Fax:770-253-7351
Practice Address - Street 1:58 HOSPITAL ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263
Practice Address - Country:US
Practice Address - Phone:770-253-9900
Practice Address - Fax:770-253-7351
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA026455207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000291849AMedicaid
GA180002775OtherRAILROAD MEDICARE
D44853Medicare UPIN
GA180002775OtherRAILROAD MEDICARE