Provider Demographics
NPI:1285262444
Name:BABERE, SIRARE HEZRON
Entity type:Individual
Prefix:
First Name:SIRARE
Middle Name:HEZRON
Last Name:BABERE
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 1:571 MARIPOSA LN
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3031
Mailing Address - Country:US
Mailing Address - Phone:404-916-1326
Mailing Address - Fax:
Practice Address - Street 1:625 CARVER RD
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-3937
Practice Address - Country:US
Practice Address - Phone:770-227-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN209504363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health