# MR. TOMMIE RUSSELL BERRY JR.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1336567007
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 35.137255 | OH | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | MD486652 | PA | Yes |
| 2081S0010X | Sports Medicine (Physical Medicine & Rehabilitation) Physician | 35.137255 | OH | — |
| 2081S0010X | Sports Medicine (Physical Medicine & Rehabilitation) Physician | 85696 | SC | — |
| 2081S0010X | Sports Medicine (Physical Medicine & Rehabilitation) Physician | 89500 | GA | — |

## Other

- **Enumeration date:** 03/31/2014
- **Last updated:** 08/28/2024