Healthcare Provider Details

I. General information

NPI: 1730476896
Provider Name (Legal Business Name): NEGA BIZUNEH GEBREMARIAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PARKWAY DR NE
ATLANTA GA
30312-1212
US

IV. Provider business mailing address

303 PARKWAY DR NE
ATLANTA GA
30312-1212
US

V. Phone/Fax

Practice location:
  • Phone: 301-281-3131
  • Fax:
Mailing address:
  • Phone: 301-281-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number071701
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5056
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number071701
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: