Provider Demographics
NPI:1275968158
Name:CHICHI BERHANE, MD, L.L.C
Entity Type:Organization
Organization Name:CHICHI BERHANE, MD, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/COO
Authorized Official - Prefix:DR
Authorized Official - First Name:MEDHANIE
Authorized Official - Middle Name:CHICHI
Authorized Official - Last Name:BERHANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-430-8917
Mailing Address - Street 1:2107 MADISON DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-2437
Mailing Address - Country:US
Mailing Address - Phone:404-430-8917
Mailing Address - Fax:404-350-7381
Practice Address - Street 1:3193 HOWELL MILL RD NW
Practice Address - Street 2:SUITE 328
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2119
Practice Address - Country:US
Practice Address - Phone:404-430-8917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68110208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty