Individual provider Active NPI

Ermias Algawork Kibru

  • Student in an Organized Health Care Education/Training Program
  • Athens, GA
National Provider Identifier
1699577213
Registry record updated Mar 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1270 Prince Ave Ste 201
Athens, GA 30606-2789
Phone
(706) 475-7055
NPI assigned
Mar 25, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

1270 Prince Ave Ste 201
Athens, GA 30606-2789

Mailing address

1270 Prince Ave Ste 102
Athens, GA 30606-2700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260623003657 TX Order and Referring Only - Diagnostic RadiologyPractitioner - Diagnostic Radiology 2961975735

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1742860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742860800000",
    "number": "1699577213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1270 PRINCE AVE STE 102",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306062700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1270 PRINCE AVE STE 201",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306062789",
            "telephone_number": "706-475-7055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIBRU",
        "first_name": "ERMIAS",
        "middle_name": "ALGAWORK",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-03-25",
        "last_updated": "2025-03-25",
        "certification_date": "2025-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Athens, GA

Sources for this page

Verify at the official NPI Registry.