Individual
BERKELEY FAYE GARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1350 WALTON WAY, AUGUSTA, GA 30901-2612
(706) 722-9011
Mailing address
1601 GREENE ST, COLUMBIA, SC 29208-4001
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN281144
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/03/2022
Last updated
09/07/2023
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