Provider Demographics
NPI:1689219958
Name:LEMMA, JONSON YEBALE SR
Entity Type:Individual
Prefix:
First Name:JONSON
Middle Name:YEBALE
Last Name:LEMMA
Suffix:SR
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 1:2116 CALLINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5946
Mailing Address - Country:US
Mailing Address - Phone:512-669-3951
Mailing Address - Fax:
Practice Address - Street 1:2116 CALLINGWOOD DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-5946
Practice Address - Country:US
Practice Address - Phone:512-669-3951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26061692172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver