Basic Information
| Provider Information | |||||||||
| NPI: | 1528412558 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABRAHA | ||||||||
| FirstName: | MERON | ||||||||
| MiddleName: | GHEBREHIWOT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 742616 | ||||||||
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| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303742616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702198420 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1968 PEACHTREE RD NW | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043673014 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2016 | ||||||||
| LastUpdateDate: | 10/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 83018 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 83018 | GA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.