Robert Ellis Berry Sr., DDS
Individual provider Active NPI Dentist · Thomson, GA
NPI 1124046974 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1124046974
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 7988 (GA)
- Practice address
- 1025C West Hill St
Thomson, GA 30824 - Phone
- (706) 595-5785
- Fax
- (706) 595-5786
- NPI assigned
- Jul 18, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150710000935 | GA | Order and Referring Only - Oral Surgery |
4587976170 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7988 | GA | MD | Medical Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 7988 | GA | Yes |
Addresses
Primary practice location
1025C West Hill St
Thomson, GA 30824
Mailing address
PO Box 638
Thomson, GA 30824-0638
Phone (706) 595-5785
Other providers in Thomson, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.