Organization
SEGEN MEDICAL GROUP, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. YACOB GHEBREMESKEL M.D. (OWNER)
(770) 939-3301
Entity
Organization
Contact information
Practice address
3950 AUSTELL RD, AUSTELL, GA 30106-1121
(770) 939-3301
(770) 939-3331
Mailing address
PO BOX 671077, MARIETTA, GA 30066-0135
(770) 939-3301
(770) 939-3331
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
45801
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000799719D
—
GA
Enumeration date
11/03/2006
Last updated
07/21/2008
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