MEDICARE: ERMESE FINNIE-SITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCAS-22331	NC

General Provider Information

NPI Number	:	1366250367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERMESE FINNIE-SITAL

Provider Business Mailing Address
First Line	:	1445 WOODMONT LN NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2866
Country	:	US
Telephone Number	:	470-264-1131
Fax Number	:

Provider Business Practice Location Address
First Line	:	3864 CHIMNEY STONE CT
Second Line	:
City	:	ELLENWOOD
State	:	GA
Zip	:	30294-1409
Country	:	US
Telephone Number	:	470-264-1211
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2024
Last Update Date	:	12/21/2024

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Directions to “ ERMESE FINNIE-SITAL ” Practice Location

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