Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0200X | Infectious Disease | 230027 | NY |
Y | 207RI0200X | Infectious Disease | 71980 | GA |
N | 207RI0200X | Infectious Disease | MD445869 | PA |
N | 207RI0200X | Infectious Disease | ME99953 | FL |
NPI | 1023166832 |
---|---|
Provider Name | Gizatchew Ketsela |
First Address | Thomasville, GA 31792-5391 |
Second Address | Thomasville, GA 31792-5391 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 28/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001919000 | (05) | FL |
003148794A | (05) | GA |
00A816110 | (05) | CA |
I25621 | (02) |