BERHANE SIRAW ASFAW (NPI# 1760593057) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760593057 |
| Entity Type | Individual |
| Full Name | BERHANE SIRAW ASFAW |
| Credential | MD |
| Practice Address |
455 Beaver Ruin Rd Nw Lilburn GA 30047-3413 |
| Mailing Address |
501 Redmond Road Rome GA 30165 |
| Practice Telephone | 7709237778 |
| Practice Fax Number | 7708061383 |
| Mailing Telephone | 7063688452 |
| Mailing Fax Number | 7063688453 |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2008-04-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 173000000X | Legal Medicine | 057771 | GA | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 734567224B | 05 | |
| GA | BCBS OF GA | 52209962 | 01 |
| Street Address |
455 BEAVER RUIN RD NW |
| City | LILBURN |
| State | GA |
| Zip Code | 30047-3413 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962451849 | Padmini Gunadeva | Family Medicine | 455 Beaver Ruin Rd Nw, Lilburn, GA 30047-3413 | 2006-05-09 |
| 1063422277 | Gwinnett Clinic,ltd | Legal Medicine | 455 Beaver Ruin Rd Nw, Lilburn, GA 30047-3413 | 2006-08-09 |
| 1033168919 | Min Jie Tan | Internal Medicine | 455 Beaver Ruin Rd Nw, Lilburn, GA 30047-3413 | 2006-05-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750861217 | Latrina S Walden | Nurse Practitioner | 887 Ryan Lane, Lilburn, GA 30047 | 2018-08-15 |
| 1811483928 | Olivia Oyegunle | Optometrist | 4153 Lawrenceville Hwy Nw Ste 5, Lilburn, GA 30047 | 2018-07-02 |
| 1932619285 | Mpm Creative, LLC | Speech-Language Pathologist | 1560 Hewatt Rd, Lilburn, GA 30047 | 2017-10-01 |
| 1528515186 | Smith Dental Care of Lilburn, Inc. | Dentist | 3100 Five Forks Trickham Rd Suite 201, Lilburn, GA 30047 | 2016-09-01 |
| 1891143244 | Choices Behavioral Alternatives | Counselor | 4037 Darling Court, Suite B, Lilburn, GA 30047 | 2016-05-26 |
| 1235595687 | Georgia Dental Associates | Clinic/Center | 3100 Five Forks Trickum Road Suite 201, Lilburn, GA 30047 | 2016-01-14 |
| 1912382144 | Sangeetha Asokan | Dentist | 609, Beaver Ruin Road, Tebo Dental for Kids, Lilburn, GA 30047 | 2015-07-29 |
| 1467836403 | Pamela Neal | Registered Nurse | 3315 Landingview Ct, Lilburn, GA 30047 | 2015-07-18 |
| 1699172452 | Josie Kou, Kulah Curran | Registered Nurse | 3708 Tamer Ln, Lilburn, GA 30047 | 2014-11-21 |
| 1184039380 | Cheryl Lee | Chiropractor | 5014 Stone Mountain Hwy, Suite C, Lilburn, GA 30047 | 2014-06-25 |
| Find all providers in zip 30047 | ||||
| Taxonomy Code | 173000000X |
| Grouping | Other Service Providers |
| Classification | Legal Medicine |
| The specialty areas of medicine concerned with matters of, and relations with, substantive law and legal institutions; such as the conduct of medical examinations at crime scenes, performance of autopsies, giving of expert medical testimony in judicial proceedings, medical treatment of inmates of penal institutions, the practice of trauma medicine in law enforcement settings, and other clinical practice and medical science applications in the fields of law, law enforcement, and corrections. |
| Notes: Source: Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063422277 | Gwinnett Clinic,ltd | Legal Medicine | 455 Beaver Ruin Rd Nw, Lilburn, GA 30047-3413 | 2006-08-09 |
| 1801845680 | Gabriel Nguena | Legal Medicine | 455 Beaver Ruin Rd, Lilburn, GA 30047 | 2006-05-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568790061 | Gwinnett Clinic, Ltd | Legal Medicine | 2748 Winder Hwy, Jefferson, GA 30549-8736 | 2009-11-23 |
| 1790939163 | Gwinnett Clinic, Ltd | Legal Medicine | 1383 Atlanta Highway, Auburn, GA 30011 | 2008-11-11 |
| 1932379666 | Medical Centre | Legal Medicine | 1815 Highway 138 Se Ste 800, Conyers, GA 30013-2098 | 2008-03-10 |
| 1215112321 | Tina M. Mason, M.d., L.L.C. | Legal Medicine | 935 River Centre Pl, Suite 200, Lawrenceville, GA 30043-7322 | 2008-01-08 |
| 1639350515 | Leeway Medical Group, PC | Legal Medicine | 1665 Waterway Xing Sw, Atlanta, GA 30331-8060 | 2007-11-19 |
| 1891975470 | Metro Vascular, P.C. | Legal Medicine | 2675 N Decatur Rd Ste 210, Suite 210, Decatur, GA 30033-6132 | 2007-11-12 |
| 1710183454 | South Atlanta Primary Care PC | Legal Medicine | 6568a Tara Blvd, Jonesboro, GA 30236-1228 | 2007-06-21 |
| 1902013709 | Winship Clinic,p.c. | Legal Medicine | 2401 Brookstone Centre Pkwy, Bldg. 200, Columbus, GA 31904-4501 | 2007-05-17 |
| 1801911789 | Ronald Ivan Kaplan | Legal Medicine | 333 Sandy Springs Cir Ne, Suite 200, Atlanta, GA 30328-3897 | 2007-03-20 |
| 1730213547 | Cobb Pulmonary Associates PC | Legal Medicine | 140 Vann St Ne Ste 340, Marietta, GA 30060-7297 | 2007-03-15 |
| Find all providers with the same taxonomy | ||||
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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.