IndividualActive
Ken Ibeto
NPI 1053807347 · Home Health Clinical Nurse Specialist · Lithia Springs, GA
Provider details
- NPI number
- 1053807347
- Entity type
- Individual
- Primary specialty
- Home Health Clinical Nurse SpecialistPhysician Assistants & Advanced Practice Nursing Providers
- Sex
- Male
- Sole proprietor
- No
- License
- 048-R-2014 (GA)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
7646 Forest Glen Way
Lithia Springs, GA 30122-6867
Phone: (678) 637-6249
Fax: (404) 393-4950
Approximate (ZIP-level) locationGet directions
Mailing address
7646 Forest Glen Way
Lithia Springs, GA 30122-6867
Registry dates
- Enumerated
- 2018-07-10
- Last updated
- 2018-07-10
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.