Provider Demographics
NPI:1023335858
Name:BERRY, JEANNA
Entity type:Individual
Prefix:
First Name:JEANNA
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 GALLATIN PIKE SOUTH
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-4627
Mailing Address - Country:US
Mailing Address - Phone:615-865-1988
Mailing Address - Fax:615-865-1983
Practice Address - Street 1:1160 GALLATIN PIKE SOUTH
Practice Address - Street 2:SUITE 203
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-4627
Practice Address - Country:US
Practice Address - Phone:615-865-1988
Practice Address - Fax:615-865-1983
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No171W00000XOther Service ProvidersContractor
No172V00000XOther Service ProvidersCommunity Health Worker
No173000000XOther Service ProvidersLegal Medicine
No174400000XOther Service ProvidersSpecialist
No1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder
No174H00000XOther Service ProvidersHealth Educator
No246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information