Individual
KEN IBETO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7646 FOREST GLEN WAY, LITHIA SPRINGS, GA 30122-6867
(678) 637-6249
(404) 393-4950
Mailing address
7646 FOREST GLEN WAY, LITHIA SPRINGS, GA 30122-6867
(678) 637-6249
(404) 393-4950
Taxonomy
Speciality
Code
Description
License number
State
364SH0200X
Home Health Clinical Nurse Specialist
Primary
048-R-2014
GA
Other
Enumeration date
07/10/2018
Last updated
07/10/2018
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