Individual provider Active NPI

Betsnat Mengesha

  • Physician Assistant
  • Tucker, GA
National Provider Identifier
1053279653
Registry record updated Jan 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
4292 Chamblee Tucker Rd
Tucker, GA 30084-2103
Phone
(770) 718-1517
NPI assigned
Jan 13, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X GA Primary

Addresses

Primary practice location

4292 Chamblee Tucker Rd
Tucker, GA 30084-2103

Mailing address

4292 Chamblee Tucker Rd
Tucker, GA 30084-2103

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260512003109 GA Practitioner - Physician Assistant 1153890801 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Philadelphia College of Osteopathic Medicine, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2370 Main St NW
Apt 2308
Duluth, GA 30097-2868

5665 New Northside Dr
Suite 320
Atlanta, GA 30328-5834

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1768262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768262400000",
    "number": "1053279653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4292 CHAMBLEE TUCKER RD",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300842103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4292 CHAMBLEE TUCKER RD",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300842103",
            "telephone_number": "770-718-1517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENGESHA",
        "first_name": "BETSNAT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-01-13",
        "last_updated": "2026-01-13",
        "certification_date": "2026-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucker, GA

Sources for this page

Verify at the official NPI Registry.