Basic Information
| Provider Information | |||||||||
| NPI: | 1346280914 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HABTEMARKOS | ||||||||
| FirstName: | REDIET | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 52007 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303550007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6783970060 | ||||||||
| FaxNumber: | 6783970065 | ||||||||
| Practice Location | |||||||||
| Address1: | 677 CHURCH ST NE | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300601101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707937750 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 10/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 26377 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 057812 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 057812 | GA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.