Provider Demographics
NPI:1346428372
Name:BERKELEY FAMILY MEDICINE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:BERKELEY FAMILY MEDICINE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:ZHANG
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-622-2566
Mailing Address - Street 1:3800 PLEASANT HILL RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1428
Mailing Address - Country:US
Mailing Address - Phone:770-622-2566
Mailing Address - Fax:770-622-0828
Practice Address - Street 1:3800 PLEASANT HILL RD
Practice Address - Street 2:SUITE 5
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1428
Practice Address - Country:US
Practice Address - Phone:770-622-2566
Practice Address - Fax:770-622-0828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060342207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty