Individual
JASON BERENDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1445 OLD MCDONOUGH HWY SE STE E, CONYERS, GA 30094-5977
(770) 922-9222
Mailing address
1445 OLD MCDONOUGH HWY SE STE E, CONYERS, GA 30094-5977
(770) 922-9222
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
067390
GA
207R00000X
Internal Medicine Physician
23298
SC
208D00000X
General Practice Physician
23298
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
232983
—
SC
01
—
571020809027
TRICARE SC
SC
01
—
571020809032
BCBS SC
SC
01
—
P00125604
RAILROAD MEDICARE
SC
Enumeration date
06/25/2006
Last updated
03/15/2022
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