Healthcare Provider Details

I. General information

NPI: 1902256928
Provider Name (Legal Business Name): MESERET MEKBIB RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 CLIFTON SPRINGS RD
DECATUR GA
30034-4600
US

IV. Provider business mailing address

3110 CLIFTON SPRINGS RD
DECATUR GA
30034-4600
US

V. Phone/Fax

Practice location:
  • Phone: 404-244-2200
  • Fax: 404-244-2209
Mailing address:
  • Phone: 404-244-2200
  • Fax: 404-244-2209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number237760
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: