Provider Demographics
NPI:1851634794
Name:BERTOLLI, NHU V (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NHU
Middle Name:V
Last Name:BERTOLLI
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:3390 PEACHTREE RD NE
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1157
Mailing Address - Country:US
Mailing Address - Phone:404-920-4950
Mailing Address - Fax:404-920-4959
Practice Address - Street 1:3390 PEACHTREE RD NE
Practice Address - Street 2:SUITE 1500
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1157
Practice Address - Country:US
Practice Address - Phone:404-920-4950
Practice Address - Fax:404-920-4959
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2015-05-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA066419363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I975345Medicare PIN