Provider Demographics
NPI:1396009882
Name:DINKU, ETALEMAHU (MD)
Entity Type:Individual
Prefix:DR
First Name:ETALEMAHU
Middle Name:
Last Name:DINKU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ETALEMAHU
Other - Middle Name:DINKU
Other - Last Name:BERHE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:677 CHURCH STREET, BOX 111
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-2440
Mailing Address - Country:US
Mailing Address - Phone:770-793-5178
Mailing Address - Fax:770-793-7755
Practice Address - Street 1:677 CHURCH STREET ,BOX 111
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2440
Practice Address - Country:US
Practice Address - Phone:770-793-5178
Practice Address - Fax:770-793-7755
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA74814207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine