Provider Demographics
NPI:1609406461
Name:GETACHEW-SMITH, ESETE
Entity Type:Individual
Prefix:
First Name:ESETE
Middle Name:
Last Name:GETACHEW-SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 PONCE DE LEON AVE NE # 100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4300
Mailing Address - Country:US
Mailing Address - Phone:470-351-4230
Mailing Address - Fax:470-351-4232
Practice Address - Street 1:725 PONCE DE LEON AVE NE # 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-4300
Practice Address - Country:US
Practice Address - Phone:470-351-4230
Practice Address - Fax:470-351-4232
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0147901835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist