Healthcare Provider Details

I. General information

NPI: 1558824011
Provider Name (Legal Business Name): YORDANOS MESFIN AGAJYELLEH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2985 MACK DOBBS RD NW
KENNESAW GA
30152-2641
US

IV. Provider business mailing address

3333 RIVERWOOD PKWY SE STE 250
ATLANTA GA
30339-3304
US

V. Phone/Fax

Practice location:
  • Phone: 770-268-4011
  • Fax: 770-955-4278
Mailing address:
  • Phone: 770-914-0016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberU2762
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number99224
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: