Individual
BERHANU EJIGU KEDEDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
5576 PRINCETON RUN TRL, TUCKER, GA 30084-8463
(678) 793-8808
Mailing address
5576 PRINCETON RUN TRL, TUCKER, GA 30084-8463
(678) 793-8808
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
202205124RN
OR
363LF0000X
Family Nurse Practitioner
Primary
RN152429
GA
Other
Enumeration date
01/06/2012
Last updated
10/09/2025
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