Provider Demographics
NPI:1679835300
Name:SETH A. BERL, MD, PC
Entity Type:Organization
Organization Name:SETH A. BERL, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BERL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-890-1441
Mailing Address - Street 1:9 HOSPITAL PARK
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-6772
Mailing Address - Country:US
Mailing Address - Phone:229-890-1442
Mailing Address - Fax:229-890-0782
Practice Address - Street 1:9 HOSPITAL PARK
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6772
Practice Address - Country:US
Practice Address - Phone:229-890-1442
Practice Address - Fax:229-890-0782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA24390207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty