Provider Demographics
NPI:1750827242
Name:ABEBE, MAHLET (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MAHLET
Middle Name:
Last Name:ABEBE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 WINDCROFT CIR NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-3797
Mailing Address - Country:US
Mailing Address - Phone:334-552-1366
Mailing Address - Fax:
Practice Address - Street 1:621 WINDCROFT CIR NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-3797
Practice Address - Country:US
Practice Address - Phone:334-552-1366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA221110364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health