Provider Demographics
NPI:1023186483
Name:UNIMEDICAL,PC
Entity Type:Organization
Organization Name:UNIMEDICAL,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EPHREM
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKONNEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-477-0849
Mailing Address - Street 1:4575 JONESBORO RD
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-4317
Mailing Address - Country:US
Mailing Address - Phone:404-477-0849
Mailing Address - Fax:404-477-0859
Practice Address - Street 1:4575 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-4317
Practice Address - Country:US
Practice Address - Phone:404-477-0849
Practice Address - Fax:404-477-0859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041874174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA85002511GMedicaid
GAG305160Medicare UPIN
GA85002511GMedicaid