Provider Demographics
NPI:1801579859
Name:FESSEHA, AKLESIA TILAHUN
Entity type:Individual
Prefix:
First Name:AKLESIA
Middle Name:TILAHUN
Last Name:FESSEHA
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 1:5343 SHERWIN DR
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-4972
Mailing Address - Country:US
Mailing Address - Phone:678-365-8795
Mailing Address - Fax:
Practice Address - Street 1:4045 FIVE FORKS TRICKUM RD SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2538
Practice Address - Country:US
Practice Address - Phone:770-381-4176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH034444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist