Provider Demographics
NPI:1417766908
Name:TESFAMICHAEL, FITSUM SEMERE
Entity type:Individual
Prefix:
First Name:FITSUM
Middle Name:SEMERE
Last Name:TESFAMICHAEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 WHITEHAWK TRL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-7160
Mailing Address - Country:US
Mailing Address - Phone:404-488-8240
Mailing Address - Fax:
Practice Address - Street 1:945 WHITEHAWK TRL
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-7160
Practice Address - Country:US
Practice Address - Phone:404-488-8240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)