Provider Demographics
NPI:1457131526
Name:MEND PRIMARY CARE LLC
Entity Type:Organization
Organization Name:MEND PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TEWODROS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEMU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-966-4740
Mailing Address - Street 1:8820 GLASGOW POINTE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-6607
Mailing Address - Country:US
Mailing Address - Phone:404-966-4740
Mailing Address - Fax:
Practice Address - Street 1:2256 NORTHLAKE PKWY STE 204A
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4004
Practice Address - Country:US
Practice Address - Phone:404-966-4740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care