Provider Demographics
NPI:1922979509
Name:BERHE, KALE-KIDAN (OD)
Entity type:Individual
Prefix:
First Name:KALE-KIDAN
Middle Name:
Last Name:BERHE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MOUNT VERNON HWY NE UNIT 30
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4295
Mailing Address - Country:US
Mailing Address - Phone:404-256-1125
Mailing Address - Fax:
Practice Address - Street 1:800 MOUNT VERNON HWY NE UNIT 30
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4295
Practice Address - Country:US
Practice Address - Phone:404-256-1125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-16
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003695152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist