Individual
LISHAN BEKELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
211 FAIRVIEW RD, ELLENWOOD, GA 30294-2721
(770) 507-4554
(770) 507-6413
Mailing address
211 FAIRVIEW RD, ELLENWOOD, GA 30294-2721
(770) 507-4554
(770) 507-6413
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
55178
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
694266528A
—
GA
Enumeration date
10/11/2007
Last updated
03/09/2009
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