Provider Demographics
NPI:1295464097
Name:BERARDI, ANTHONY MARK (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:MARK
Last Name:BERARDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BERTRAM CT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-2144
Mailing Address - Country:US
Mailing Address - Phone:864-982-5039
Mailing Address - Fax:
Practice Address - Street 1:3642 WHEELER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6519
Practice Address - Country:US
Practice Address - Phone:706-496-2573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13842207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine