Basic Information
| Provider Information | |||||||||
| NPI: | 1740269760 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERRY | ||||||||
| FirstName: | GIRARD | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 BRENNER AVE | ||||||||
| Address2: | VETERAN AFFAIRS, PSYCHIATRY | ||||||||
| City: | SALISBURY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281442515 | ||||||||
| CountryCode: | US | ||||||||
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| FaxNumber: | 3362779275 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 BRENNER AVE | ||||||||
| Address2: | VETERAN AFFAIRS, PSYCHIATRY | ||||||||
| City: | SALISBURY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281442515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046389000 | ||||||||
| FaxNumber: | 3362779275 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 03/25/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 000100827 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.