Healthcare Provider Details

I. General information

NPI: 1770797904
Provider Name (Legal Business Name): MEDHANIE CHICHI BERHANE M.D, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/11/2014
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

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

V. Phone/Fax

Practice location:
  • Phone: 404-350-9355
  • Fax: 404-350-9069
Mailing address:
  • Phone: 404-350-9355
  • Fax: 404-350-9069

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:
Title or Position:
Credential:
Phone: