BERHANU EJIGU KEDEDA (NPI# 1184994105) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184994105 |
| Entity Type | Individual |
| Full Name | BERHANU EJIGU KEDEDA |
| Other Name | BERHANU KEDIDA EJIGU |
| Credential | NP-C |
| Practice Address |
5576 Princeton Run Trl Tucker GA 30084-8463 |
| Practice Telephone | 6787938808 |
| Mailing Telephone | 6787938808 |
| Enumeration Date | 2012-01-06 |
| Last Update Date | 2012-01-06 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
RN152429 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
5576 PRINCETON RUN TRL |
| City | TUCKER |
| State | GA |
| Zip Code | 30084-8463 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609401355 | Excellent Medical Transport | Ambulance | 4378 Sentry Dr, Tucker, GA 30084 | 2020-03-03 |
| 1811468796 | Caleb Lee Ebbets | Physical Therapist | 1459 Montreal Road, Medical Office Building, Suite 301, Tucker, GA 30084 | 2018-12-17 |
| 1417436130 | Benjamin Han Wook Chong | Physical Therapist | 1460 Montreal Road East, Suite 300, Tucker, GA 30084 | 2018-08-13 |
| 1336659325 | Lavista Acupuncture and Herbal Medicine | Acupuncturist | 4915 Lavista Rd, Tucker, GA 30084 | 2017-10-04 |
| 1699294207 | Debrica Butler | Counselor | 1021 Oak Chase Dr., Apt C, Tucker, GA 30084 | 2017-09-14 |
| 1295264695 | Jolanta Wazgowska Hopkins | Social Worker | 4404 Idlewood Lane, Tucker, GA 30084 | 2017-06-08 |
| 1164956157 | Sage Dental Group of Georgia LLC | Dentist | 4320 Lavista Rd, Suite C119, Tucker, GA 30084 | 2017-04-17 |
| 1689107807 | Mashail Manzur | Podiatrist | 1460 Montreal Rd E, Ste 275, Tucker, GA 30084 | 2017-04-05 |
| 1053765578 | Jessica Spruyt | Speech-Language Pathologist | 3756 Lavista Rd Suite 104, Tucker, GA 30084 | 2016-04-21 |
| 1265802318 | Spine and Orthopedics of Atlanta, LLC | Clinic/Center | 1462 Montreal Rd Ste 218, Tucker, GA 30084 | 2015-10-01 |
| Find all providers in zip 30084 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326506932 | Chandra Charlotin | Nurse Practitioner | 559 Commons Park Ln, Tucker, GA 30084-8925 | 2019-03-04 |
| 1992261838 | Hospice Advantage, LLC | Nurse Practitioner | 100 Crescent Center Pkwy Ste 220, Tucker, GA 30084-7049 | 2019-02-15 |
| 1790264703 | Alison Diane Bizarroque | Nurse Practitioner | 436 Engle Dr, Tucker, GA 30084-2015 | 2018-08-09 |
| 1083191654 | Melanie Noelle Mcmillan | Nurse Practitioner | 2260 Northlake Pkwy Ste 211, Tucker, GA 30084-4006 | 2018-07-25 |
| 1790295053 | Karrie Jo Shell | Nurse Practitioner | 2258 Northlake Pkwy Ste 100, Tucker, GA 30084-4020 | 2017-10-02 |
| 1104355908 | Cassandra A Westbrook | Nurse Practitioner | 4088 Brookside Manor Dr, Tucker, GA 30084-7800 | 2017-06-06 |
| 1881129807 | Bessie Martin-jackson | Nurse Practitioner | 1957 Lakeside Pkwy Ste 500, Tucker, GA 30084-5859 | 2017-04-27 |
| 1346786779 | Tracy Ann Daye | Nurse Practitioner | 8307 Five Oaks Way, Tucker, GA 30084-8185 | 2017-01-09 |
| 1225570617 | Libya Michelle King | Nurse Practitioner | 519 Commons Park Ln, Tucker, GA 30084-8925 | 2016-11-16 |
| 1154657625 | Katrice Hollis Berry | Nurse Practitioner | 1459 Montreal Rd Ste 305, Tucker, GA 30084 | 2009-10-19 |
| Find all providers in TUCKER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.