Healthcare Provider Details

I. General information

NPI: 1407499452
Provider Name (Legal Business Name): JULIUS ATEMAFAC ED.D, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13944 BALTIMORE AVE STE 102
LAUREL MD
20707-5000
US

IV. Provider business mailing address

713 REXFORD WAY
UPPER MARLBORO MD
20774-8441
US

V. Phone/Fax

Practice location:
  • Phone: 240-491-2868
  • Fax: 866-207-0983
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR176168
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: