Provider Demographics
NPI:1164015111
Name:BERRYMAN, MEREDITH 3108045586
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:3108045586
Last Name:BERRYMAN
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 1:3544 STRATH DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-2802
Mailing Address - Country:US
Mailing Address - Phone:310-804-5586
Mailing Address - Fax:
Practice Address - Street 1:3544 STRATH DR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-2802
Practice Address - Country:US
Practice Address - Phone:310-804-5586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service