Provider Demographics
NPI:1649270885
Name:BERNE, JORDAN H (MD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:H
Last Name:BERNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6095 BARFIELD RD NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4408
Mailing Address - Country:US
Mailing Address - Phone:404-851-1766
Mailing Address - Fax:404-851-1767
Practice Address - Street 1:6095 BARFIELD RD NE
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4408
Practice Address - Country:US
Practice Address - Phone:404-851-1766
Practice Address - Fax:404-851-1767
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA047399207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00837031AMedicaid
GAG64492Medicare UPIN
GA22BDCXZMedicare ID - Type Unspecified