Provider Demographics
NPI:1003399973
Name:ATEM, MACROY FORLU
Entity Type:Individual
Prefix:
First Name:MACROY
Middle Name:FORLU
Last Name:ATEM
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 1:9867 GOOD LUCK RD APT 12
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3227
Mailing Address - Country:US
Mailing Address - Phone:240-970-3060
Mailing Address - Fax:
Practice Address - Street 1:9867 GOOD LUCK RD APT 12
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3227
Practice Address - Country:US
Practice Address - Phone:240-970-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12074374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide