Provider Demographics
NPI:1659552115
Name:CLAIRMONT MEDICAL CLINIC LLC BELACHEW YOHANNES A EI AL MBR
Entity Type:Organization
Organization Name:CLAIRMONT MEDICAL CLINIC LLC BELACHEW YOHANNES A EI AL MBR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:YOHANNES
Authorized Official - Middle Name:A
Authorized Official - Last Name:BELACHEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-477-1218
Mailing Address - Street 1:3490 CLAIRMONT RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3758
Mailing Address - Country:US
Mailing Address - Phone:404-477-1218
Mailing Address - Fax:
Practice Address - Street 1:3490 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319
Practice Address - Country:US
Practice Address - Phone:404-477-1218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QP2300X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11SCDDCMedicare PIN