Healthcare Provider Details

I. General information

NPI: 1750827242
Provider Name (Legal Business Name): MAHLET MULUGETA ABEBE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 WADE GREEN RD NW STE 414
KENNESAW GA
30144-1763
US

IV. Provider business mailing address

4255 WADE GREEN RD NW STE 414
KENNESAW GA
30144-1763
US

V. Phone/Fax

Practice location:
  • Phone: 770-389-8100
  • Fax:
Mailing address:
  • Phone: 678-213-2194
  • Fax: 678-922-7767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP221110
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN221110
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: