Provider Demographics
NPI:1891990743
Name:BERNARD, PAUL JEROME (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JEROME
Last Name:BERNARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10700 MEDLOCK BRIDGE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8456
Mailing Address - Country:US
Mailing Address - Phone:678-691-5351
Mailing Address - Fax:770-685-1241
Practice Address - Street 1:10700 MEDLOCK BRIDGE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-8456
Practice Address - Country:US
Practice Address - Phone:678-691-5351
Practice Address - Fax:770-685-1241
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20070159222080P0205X
GA0600452080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204462808Medicaid