Provider Demographics
NPI:1982391629
Name:ABU, SEFIATU (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SEFIATU
Middle Name:
Last Name:ABU
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2640
Mailing Address - Country:US
Mailing Address - Phone:770-991-8500
Mailing Address - Fax:
Practice Address - Street 1:110 W PIER WAY # A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4617
Practice Address - Country:US
Practice Address - Phone:908-906-0931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN2533632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry