Individual provider Active NPI

Mesafint Tadesse Shiferaw, MD

  • Pediatric Critical Care Medicine Physician
  • Marietta, GA
National Provider Identifier
1346735180
Registry record updated Sep 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
99136 Issued in GA
Practice address
677 Church St NE
Marietta, GA 30060-1101
Phone
(770) 793-5000
NPI assigned
Jun 25, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 99136 GA
Student in an Organized Health Care Education/Training Program 390200000X TRN26986 FL
Pediatric Critical Care Medicine Physician 2080P0203X 99136 GA Primary

Addresses

Primary practice location

677 Church St NE
Marietta, GA 30060-1101

Mailing address

677 Church St NE
Marietta, GA 30060-1101
Phone (770) 793-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260203004509 LA Practitioner - Pediatric Medicine 4789162314 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Other, 2018
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1514 Jefferson Hwy
New Orleans, LA 70121

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
99136GAMDPediatrics Physician
TRN26986FLMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Ochsner Clinic LLC CurrentSince Dec 23, 2025 Accepting new patients
Ochsner Clinic LLC CurrentSince Dec 23, 2025 Accepting new patients
Pediatrix Medical Group of Georgia, P.C. Pediatric Critical Care Medicine Past Accepting new patients
Kennestone Hospital, Inc. Past Accepting new patients

Locations

1514 Jefferson Hwy
New Orleans, LA 70121

104 Acadia Park Dr
Raceland, LA 70394
Phone (985) 537-3211

100 Medical Center Dr
Slidell, LA 70461
Phone (504) 392-3131

Interoperability endpoints

  • Direct secure messaging: mshiferaw2462986@direct.ochsner.org

Organizations & group practices 5

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": "1529884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725667200000",
    "number": "1346735180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "677 CHURCH ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601101",
            "telephone_number": "770-793-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "677 CHURCH ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601101",
            "telephone_number": "770-793-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIFERAW",
        "first_name": "MESAFINT",
        "middle_name": "TADESSE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-25",
        "last_updated": "2024-09-07",
        "certification_date": "2024-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "99136",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": "TRN26986",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "GA",
            "license": "99136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.