Provider Demographics
NPI:1497916753
Name:BERRY, PHILIP ALTON (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:ALTON
Last Name:BERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 PEACHTREE ST NE STE 1900
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3578
Mailing Address - Country:US
Mailing Address - Phone:404-482-3366
Mailing Address - Fax:562-261-1048
Practice Address - Street 1:1230 PEACHTREE ST NE STE 1900
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3578
Practice Address - Country:US
Practice Address - Phone:404-482-3366
Practice Address - Fax:562-261-1048
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA72184207RE0101X
KY49700207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism