Provider Demographics
NPI:1487623336
Name:BERL, SETH ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:ALLEN
Last Name:BERL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9 HOSPITAL PARK
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-6772
Mailing Address - Country:US
Mailing Address - Phone:229-891-5308
Mailing Address - Fax:229-616-1165
Practice Address - Street 1:9 HOSPITAL PARK
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6772
Practice Address - Country:US
Practice Address - Phone:229-891-5308
Practice Address - Fax:229-616-1165
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024390207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA110021285OtherRR MEDICARE
GA000253646DMedicaid
GAD39396Medicare UPIN