Healthcare Provider Details

I. General information

NPI: 1023845880
Provider Name (Legal Business Name): SALAM CLINIC PRIMARY AND URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5468 MEMORIAL DR STE D
STONE MOUNTAIN GA
30083-3267
US

IV. Provider business mailing address

5468 MEMORIAL DR STE D
STONE MOUNTAIN GA
30083-3267
US

V. Phone/Fax

Practice location:
  • Phone: 404-963-2142
  • Fax: 404-963-2098
Mailing address:
  • Phone: 404-963-2142
  • Fax: 404-963-2098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SELAMAWIT MOLA
Title or Position: MANAGER
Credential: FNP
Phone: 469-355-5339