Provider Demographics
NPI:1639814114
Name:KASSAHUN, ERMIAS YIRGA
Entity Type:Individual
Prefix:MR
First Name:ERMIAS
Middle Name:YIRGA
Last Name:KASSAHUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 ALEC CT
Mailing Address - Street 2:
Mailing Address - City:NOLENSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37135-9735
Mailing Address - Country:US
Mailing Address - Phone:615-719-4208
Mailing Address - Fax:
Practice Address - Street 1:813 ALEC CT
Practice Address - Street 2:
Practice Address - City:NOLENSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37135-9735
Practice Address - Country:US
Practice Address - Phone:615-719-4208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN001309136374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide