Healthcare Provider Details

I. General information

NPI: 1275968158
Provider Name (Legal Business Name): CHICHI BERHANE, MD, L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3193 HOWELL MILL RD NW SUITE 328
ATLANTA GA
30327-2119
US

IV. Provider business mailing address

2107 MADISON DR
ATLANTA GA
30346-2437
US

V. Phone/Fax

Practice location:
  • Phone: 404-430-8917
  • Fax:
Mailing address:
  • Phone: 404-430-8917
  • Fax: 404-350-7381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number68110
License Number StateGA

VIII. Authorized Official

Name: DR. MEDHANIE CHICHI BERHANE
Title or Position: CEO/COO
Credential: MD
Phone: 404-430-8917