Provider Demographics
NPI:1649468463
Name:JOSEPH H. BERGER, MD, LLC
Entity type:Organization
Organization Name:JOSEPH H. BERGER, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:H
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-228-6355
Mailing Address - Street 1:305 W HANSELL ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6649
Mailing Address - Country:US
Mailing Address - Phone:229-228-6355
Mailing Address - Fax:229-228-6841
Practice Address - Street 1:305 W HANSELL ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6649
Practice Address - Country:US
Practice Address - Phone:229-228-6355
Practice Address - Fax:229-228-6841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028722207YX0007X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACB4831OtherRAILROAD MEDICARE
GAGRP3834Medicare PIN
GAD44851Medicare UPIN