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General NPI Number Information
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NPI Number | 1285094433
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Entity Type | Individual
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Provider Name | MUSSIE ASMEROM NNP-BC
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Gender | Male
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Dates
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Enumeration Date | 03/01/2016
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 3773 IVEY LN SW
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City | LILBURN
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State | GA
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Zip | 30047-2155
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Country | US
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Telephone | 770-595-5276
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Fax |
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Provider Business Mailing Address
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Address Line | 1711 TULLIE CIR NE
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City | ATLANTA
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State | GA
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Zip | 30329-2305
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Country | US
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Telephone | 404-785-5413
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Fax | 404-785-6233
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LN0005X
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Taxonomy Name | Critical Care Neonatal Nurse Practitioner
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License Number | RN190757
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | LM-0000137
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License Number State | DE
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | LM-0000137
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License Number State | DE
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