Provider Demographics
NPI:1316128507
Name:JAY S. BERGER, M.D., P.C.
Entity type:Organization
Organization Name:JAY S. BERGER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-253-9900
Mailing Address - Street 1:58 HOSPITAL RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1230
Mailing Address - Country:US
Mailing Address - Phone:770-253-9900
Mailing Address - Fax:770-253-7351
Practice Address - Street 1:58 HOSPITAL RD
Practice Address - Street 2:SUITE 203
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1230
Practice Address - Country:US
Practice Address - Phone:770-253-9900
Practice Address - Fax:770-253-7351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026455174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADF0267OtherRAILROAD MEDICARE
GADF0267OtherRAILROAD MEDICARE