Bernardy, Mark Otto
Bernardy, Mark Otto is an individual health care provider with primary practice located at 1031 Jimson Dr Se , Conyers GA 30013-2064. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Bernardy, Mark Otto can be contacted via phone (800) 879-6274.Contact Information
Primary practice address
1031 Jimson Dr Se
Conyers GA 30013-2064
Phone: (800) 879-6274
Fax: (678) 342-2547
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 028502 | Georgia |
Profile Details
| NPI number | 1861478588 |
|---|---|
| LBN Legal business name | Bernardy, Mark Otto |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 15th, 2005 |
| Last updated | Feb 29th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1861478588 | NPPES |
| Other | P00256142 | RR MEDICARE |
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