Provider Demographics
NPI:1629209952
Name:MICHAEL A BERRY
Entity Type:Organization
Organization Name:MICHAEL A BERRY
Other - Org Name:MICHAEL A BERRY M.D., PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAIN/GENERAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-329-9302
Mailing Address - Street 1:PO BOX 1019
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39703-1019
Mailing Address - Country:US
Mailing Address - Phone:662-329-9302
Mailing Address - Fax:662-328-7597
Practice Address - Street 1:255 BAPTIST BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2011
Practice Address - Country:US
Practice Address - Phone:662-329-9302
Practice Address - Fax:662-328-7597
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL A BERRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-04
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20632208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty