Provider Demographics
NPI:1285990317
Name:BERRY, JULIA PENDERGRAST (NP-C)
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:PENDERGRAST
Last Name:BERRY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:BRADFIELD
Other - Last Name:PENDERGRAST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:136 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3540
Mailing Address - Country:US
Mailing Address - Phone:404-313-0594
Mailing Address - Fax:
Practice Address - Street 1:1875 CENTURY BLVD NE
Practice Address - Street 2:SUITE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3325
Practice Address - Country:US
Practice Address - Phone:404-633-4595
Practice Address - Fax:404-633-6637
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN186162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily