MEDICARE: SELAMAWIT Y MAMO

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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1457286510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELAMAWIT Y MAMO

Provider Business Mailing Address
First Line	:	687 FORD AVE
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-5767
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	687 FORD AVE
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-5767
Country	:	US
Telephone Number	:	404-695-8026
Fax Number	:

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

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/17/2026

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Directions to “ SELAMAWIT Y MAMO ” Practice Location

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