MEDICARE: YOHANNES ALI BELACHEW M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	050940	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11SCDDC	OTHER	GA	PIN

General Provider Information

NPI Number	:	1871586693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOHANNES ALI BELACHEW M.D

Provider Business Mailing Address
First Line	:	3490 CLAIRMONT RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30319-3758
Country	:	US
Telephone Number	:	404-477-1218
Fax Number	:	404-477-1219

Provider Business Practice Location Address
First Line	:	3490 CLAIRMONT RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30319-3758
Country	:	US
Telephone Number	:	404-477-1218
Fax Number	:	404-477-1219

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	07/08/2007

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