Provider Demographics
NPI:1790780195
Name:KEBEDE, SOSENA (MD)
Entity type:Individual
Prefix:DR
First Name:SOSENA
Middle Name:
Last Name:KEBEDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6455 BEST FRIEND RD
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-2914
Mailing Address - Country:US
Mailing Address - Phone:770-754-5150
Mailing Address - Fax:678-762-4098
Practice Address - Street 1:6455 BEST FRIEND RD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-2914
Practice Address - Country:US
Practice Address - Phone:770-754-5150
Practice Address - Fax:678-762-4098
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2003-00820207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH-86993Medicare UPIN