Provider Demographics
NPI:1184626640
Name:BERMAN, LAWRENCE DAVID (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:DAVID
Last Name:BERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LARRY
Other - Middle Name:
Other - Last Name:BERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:245 SNOWGOOSE CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-2466
Mailing Address - Country:US
Mailing Address - Phone:706-302-4750
Mailing Address - Fax:706-423-9443
Practice Address - Street 1:4535 WINTERS CHAPEL RD STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30360-2705
Practice Address - Country:US
Practice Address - Phone:678-580-1862
Practice Address - Fax:678-580-1648
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035374207L00000X, 207LP2900X, 208VP0014X
AL17570207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000495778EMedicaid
GA000495778LMedicaid
GA000495778EMedicaid
GA202I057299Medicare PIN
05BDKVQMedicare ID - Type Unspecified