Provider Demographics
NPI:1780742510
Name:OREWA, BERNARD N (MD)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:N
Last Name:OREWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5987 MABLETON PKWY
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-3347
Mailing Address - Country:US
Mailing Address - Phone:770-941-4012
Mailing Address - Fax:770-941-7433
Practice Address - Street 1:5987 MABLETON PKWY
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-3347
Practice Address - Country:US
Practice Address - Phone:770-941-4012
Practice Address - Fax:770-941-7433
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051527207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA01034588OtherAMERIGROUP
GA203837351OtherBLUE SHIELD
GA455155851AMedicaid
GA178074OtherUNITED HEALTHCARE UPIN
GAP00471327OtherRAILROAD MEDICARE
GAH46945Medicare UPIN
GA178074OtherUNITED HEALTHCARE UPIN
GAP00471327OtherRAILROAD MEDICARE
GA455155851AMedicaid