Provider Demographics
NPI:1437251410
Name:BERGER, JOSEPH H (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:H
Last Name:BERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:H
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:305 W HANSELL ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6649
Mailing Address - Country:US
Mailing Address - Phone:229-228-6355
Mailing Address - Fax:229-228-6841
Practice Address - Street 1:305 W HANSELL ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6649
Practice Address - Country:US
Practice Address - Phone:229-228-6355
Practice Address - Fax:229-228-6841
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028722207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000328512AMedicaid
GA010015083OtherRAILROAD MEDICARE
GAN207140OtherWELLCARE
GA000328512AOtherPEACH STATE
GAN207140OtherWELLCARE