Provider Demographics
NPI:1598395071
Name:BERRY, NADIYAH
Entity type:Individual
Prefix:
First Name:NADIYAH
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 HAMILTON E HOLMES DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-6124
Mailing Address - Country:US
Mailing Address - Phone:314-585-2080
Mailing Address - Fax:
Practice Address - Street 1:648 HAMILTON E HOLMES DR NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-6124
Practice Address - Country:US
Practice Address - Phone:314-585-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
173C00000X, 374J00000X
GAMT012751225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist
No374J00000XNursing Service Related ProvidersDoula