MEDICARE: MR. MUSSIE ASMEROM NNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LN0005X	Critical Care Neonatal Nurse Practitioner	RN190757	GA
2	363LN0000X	Neonatal Nurse Practitioner	APRN-NP190757	GA
3	363L00000X	Nurse Practitioner	LM-0000137	DE
4	363LN0000X	Neonatal Nurse Practitioner	LM-0000137	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1285094433	OTHER		NPI

General Provider Information

NPI Number	:	1285094433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MUSSIE ASMEROM NNP-BC

Provider Business Mailing Address
First Line	:	1711 TULLIE CIR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-2305
Country	:	US
Telephone Number	:	404-785-5413
Fax Number	:	404-785-6233

Provider Business Practice Location Address
First Line	:	3773 IVEY LN SW
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-2155
Country	:	US
Telephone Number	:	770-595-5276
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2016
Last Update Date	:	05/26/2026

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