Provider Demographics
NPI:1114222676
Name:KASSA, YILIKAL TASSEW (MD)
Entity Type:Individual
Prefix:
First Name:YILIKAL
Middle Name:TASSEW
Last Name:KASSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1157
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30015-1157
Mailing Address - Country:US
Mailing Address - Phone:678-413-3261
Mailing Address - Fax:678-413-3580
Practice Address - Street 1:1612 MILSTEAD RD NE
Practice Address - Street 2:SUITE A
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3738
Practice Address - Country:US
Practice Address - Phone:678-413-3261
Practice Address - Fax:678-413-3580
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA070175207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology