Individual
HAILEYESUS FENTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1517 AINSLIE PLACE RD, INDIAN TRAIL, NC 28079-5836
(404) 246-6483
Mailing address
1517 AINSLIE PLACE RD, INDIAN TRAIL, NC 28079-5836
(404) 246-6483
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
09/20/2024
Last updated
11/04/2024
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