Provider Demographics
NPI:1588612253
Name:BERRY, CURRELL VANCE (MD)
Entity Type:Individual
Prefix:DR
First Name:CURRELL
Middle Name:VANCE
Last Name:BERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2001 PEACHTREE RD NE
Mailing Address - Street 2:SUITE #425
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1423
Mailing Address - Country:US
Mailing Address - Phone:404-355-1290
Mailing Address - Fax:
Practice Address - Street 1:2001 PEACHTREE RD NE
Practice Address - Street 2:SUITE #425
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1476
Practice Address - Country:US
Practice Address - Phone:404-355-1290
Practice Address - Fax:404-355-1469
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015763207W00000X
GA027495207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD39400Medicare UPIN
GA18BDBGVMedicare ID - Type Unspecified