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General NPI Number Information
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NPI Number | 1518342914
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Entity Type | Individual
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Provider Name | DR. ASFAW AMBAYE
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Gender | Male
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Dates
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Enumeration Date | 07/27/2015
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 3650 MARKETPLACE BLVD STE 920
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City | EAST POINT
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State | GA
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Zip | 30344-5742
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Country | US
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Telephone | 678-515-0746
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Fax | 470-355-2166
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Provider Business Mailing Address
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Address Line | 4145 LAWRENCEVILLE HWY NW STE 15
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City | LILBURN
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State | GA
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Zip | 30047-2807
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Country | US
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Telephone | 678-515-0746
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Fax | 470-355-2166
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN015057
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License Number State | GA
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