Provider Demographics
NPI:1609453240
Name:GEBREMEDHINE, BEZA (MD)
Entity type:Individual
Prefix:DR
First Name:BEZA
Middle Name:
Last Name:GEBREMEDHINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 MANHATTAN PKWY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-2251
Mailing Address - Country:US
Mailing Address - Phone:404-453-3006
Mailing Address - Fax:
Practice Address - Street 1:2033 MANHATTAN PKWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-2251
Practice Address - Country:US
Practice Address - Phone:404-453-3006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA99178207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine