1659552115 NPI number — CLAIRMONT MEDICAL CLINIC LLC BELACHEW YOHANNES A EI AL MBR

Table of content: MS. STEPHANIE LEE ZIMMER LMHC (NPI 1871273136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659552115 NPI number — CLAIRMONT MEDICAL CLINIC LLC BELACHEW YOHANNES A EI AL MBR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLAIRMONT MEDICAL CLINIC LLC BELACHEW YOHANNES A EI AL MBR
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659552115
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3490 CLAIRMONT RD NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30319-3758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-477-1218
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3490 CLAIRMONT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-477-1218
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BELACHEW
Authorized Official First Name:
YOHANNES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
404-477-1218

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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