Provider Demographics
NPI:1811758378
Name:GEBREMARIAM, GIRMA B
Entity type:Individual
Prefix:MR
First Name:GIRMA
Middle Name:B
Last Name:GEBREMARIAM
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 1:6602 FALCON ST
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-2901
Mailing Address - Country:US
Mailing Address - Phone:404-988-0557
Mailing Address - Fax:
Practice Address - Street 1:6602 FALCON ST
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-2901
Practice Address - Country:US
Practice Address - Phone:404-988-0557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45236014172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver