Provider Demographics
NPI:1104454727
Name:GEBREYESUS, TRAM-HUONG (LAC)
Entity type:Individual
Prefix:MRS
First Name:TRAM-HUONG
Middle Name:
Last Name:GEBREYESUS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 DALLAS HWY SW STE 170
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1696
Mailing Address - Country:US
Mailing Address - Phone:404-680-0671
Mailing Address - Fax:
Practice Address - Street 1:3600 DALLAS HWY SW STE 170
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1696
Practice Address - Country:US
Practice Address - Phone:404-680-0671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA432171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist