Memorial Drive Family Medicine P.C

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MEMORIAL DRIVE FAMILY MEDICINE P.C

Practice address

4958 Memorial Dr
Stone Mountain, GA 30083-4148

Phone

(404) 809-2480

Fax

(404) 809-2485

NPI assigned

May 23, 2012

Last updated

Jul 12, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Tassew Tesfaye, M.D.NPI 1710974696

Title

Medical Doctor

Phone

(404) 809-2480

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tassew Tesfaye, M.D.

  • Family Medicine Physician
  • Stone Mountain, GA
  • NPI 1710974696
  Medicare reassignment NPD Authorized official
• Melodie Olivieri, FNP

  • Family Nurse Practitioner
  • Lawrenceville, GA
  • NPI 1013774033
  NPD (past)
• Marshet Tenaw

  • Family Nurse Practitioner
  • Stone Mountain, GA
  • NPI 1366158669
  NPD (past)
• Selamawit Wehabe Tsega, MDCE

  • Physician Assistant
  • Stone Mountain, GA
  • NPI 1902746530
  NPD (past)

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

{
    "created_epoch": "1337731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342051200000",
    "number": "1285994251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4958 MEMORIAL DR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300834148",
            "telephone_number": "404-809-2480",
            "fax_number": "404-809-2485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4958 MEMORIAL DR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300834148",
            "telephone_number": "404-809-2480",
            "fax_number": "404-809-2485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL DRIVE FAMILY MEDICINE P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-23",
        "last_updated": "2012-07-12",
        "status": "A",
        "authorized_official_last_name": "TESFAYE",
        "authorized_official_first_name": "TASSEW",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "404-809-2480",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Morgan Merriweather

• Family Medicine Physician in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.