Provider Demographics
NPI:1205237393
Name:MATTHES BERG, ANDREA LINN (DHSC, LAT, ATC)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LINN
Last Name:MATTHES BERG
Suffix:
Gender:F
Credentials:DHSC, LAT, ATC
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:LINN
Other - Last Name:MATTHES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DHSC, LAT, ATC
Mailing Address - Street 1:3880 STRATFORD CIR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-4855
Mailing Address - Country:US
Mailing Address - Phone:405-248-3823
Mailing Address - Fax:
Practice Address - Street 1:7196 SAVANNAH ST # B
Practice Address - Street 2:
Practice Address - City:MOODY AFB
Practice Address - State:GA
Practice Address - Zip Code:31699-5013
Practice Address - Country:US
Practice Address - Phone:229-257-3826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0026302255A2300X
OK3082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer