Provider Demographics
NPI:1407942972
Name:WOLFBERG, BERNARD BEHR (MD)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:BEHR
Last Name:WOLFBERG
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 1:1040 CAMBRIDGE SQUARE
Mailing Address - Street 2:SUITE D
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-1800
Mailing Address - Country:US
Mailing Address - Phone:770-664-6229
Mailing Address - Fax:770-664-6684
Practice Address - Street 1:1040 CAMBRIDGE SQUARE
Practice Address - Street 2:SUITE D
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-1800
Practice Address - Country:US
Practice Address - Phone:770-664-6229
Practice Address - Fax:770-664-6684
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0347442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00473877AMedicaid
26BDBRNMedicare ID - Type Unspecified
GA00473877AMedicaid