Provider Demographics
NPI:1730894478
Name:TSEGAYE, YODIT DEMEKE
Entity type:Individual
Prefix:
First Name:YODIT
Middle Name:DEMEKE
Last Name:TSEGAYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-1141
Mailing Address - Country:US
Mailing Address - Phone:678-933-5121
Mailing Address - Fax:
Practice Address - Street 1:1208 LAKEVIEW RD
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-1141
Practice Address - Country:US
Practice Address - Phone:678-933-5121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)