Individual
MARK OTTO BERNARDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1031 JIMSON DR SE, CONYERS, GA 30013-2064
(800) 879-6274
(678) 342-2547
Mailing address
1031 JIMSON DR SE, CONYERS, GA 30013-2064
(800) 879-6274
(678) 342-2547
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
028502
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00256142
RR MEDICARE
—
Enumeration date
12/15/2005
Last updated
02/29/2008
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