Provider Demographics
NPI:1669588463
Name:BERRYMAN, BILL G (MD)
Entity type:Individual
Prefix:
First Name:BILL
Middle Name:G
Last Name:BERRYMAN
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 1:1810 STADIUM DRIVE
Mailing Address - Street 2:#140
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867
Mailing Address - Country:US
Mailing Address - Phone:334-214-4616
Mailing Address - Fax:334-214-4618
Practice Address - Street 1:1810 STADIUM DRIVE
Practice Address - Street 2:#140
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867
Practice Address - Country:US
Practice Address - Phone:334-664-1969
Practice Address - Fax:888-391-2191
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114982207L00000X
AK4399207L00000X
PAMD-070139-L207L00000X
ARE-3049207L00000X
MT8798207L00000X
WV22130207L00000X
KS04-29071207L00000X
IL036-071941207L00000X
GA058573207L00000X
FLME103218207L00000X
CAA44553207L00000X
AL00026975207L00000X
AL26975208D00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1669588463OtherPAIN MANAGEMENT