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1114572716
DEREK BERTA
COLUMBIA, SC
NPI
1114572716
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: SC 4293)
Additional Taxonomies
363A00000X Physician Assistant
Enumeration Date
2019-08-09
Last Update Date
2022-06-06
Business Address
DEREK BERTA
2750 LAUREL ST STE 305
COLUMBIA, SC 29204-2025
Phone number: 803-254-5140
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Mailing Address
DEREK BERTA
PO BOX 935722
ATLANTA, GA 31193-5722
Phone number: 843-792-6200
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