Active NPI
Aaron Bergman
- Specialist
- Atlanta, GA
National Provider Identifier
1114307675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- PTA003414
- Practice address
- 1005 Virginia Ave
Suite 100
Atlanta, GA 30354-1326 - Phone
- (404) 762-1001
- NPI assigned
- May 31, 2015
- Last updated
- May 31, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | PTA003414 | GA | Primary |
Addresses
Primary practice location
1005 Virginia Ave
Suite 100
Atlanta, GA 30354-1326
Mailing address
340 Senior Dr
Lawrenceville, GA 30044-5462
Phone (239) 246-3975
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA003414 | GA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1433030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433030400000",
"number": "1114307675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "340 SENIOR DR",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300445462",
"telephone_number": "239-246-3975"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1005 VIRGINIA AVE",
"address_2": "SUITE 100",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303541326",
"telephone_number": "404-762-1001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGMAN",
"first_name": "AARON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-05-31",
"last_updated": "2015-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "GA",
"license": "PTA003414",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.