Mahelate Theodros, DO

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

109399 Issued in GA

Practice address

500 Medical Center Blvd Ste 190
Lawrenceville, GA 30046-3379

Phone

(770) 643-4115

Fax

(678) 377-3820

NPI assigned

Sep 6, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Obstetrics/Gynecology

Education

Pacific NW Un of HS, Col of Osteopathic Medicine, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gwinnett Physician Group, LLCGroup PAC ID 9133211139, 112 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mahelate.theodros.1@14448.direct.athenahealth.com

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.

• Gwinnett Physician Group, LLC

  • Internal Medicine Physician
  • Lawrenceville, GA
  • NPI 1578574661

  Obstetrics & Gynecology

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1567728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756252800000",
    "number": "1518516145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 MEDICAL CENTER BLVD STE 190",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463379",
            "telephone_number": "770-643-4115",
            "fax_number": "678-377-3820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 MEDICAL CENTER BLVD STE 190",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463379",
            "telephone_number": "770-643-4115",
            "fax_number": "678-377-3820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEODROS",
        "first_name": "MAHELATE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-06",
        "last_updated": "2025-08-27",
        "certification_date": "2025-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "109399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Social Empowerment Center
• The Spahhh, Inc.
• Themindhealer, Inc.
• Viviane Andreia Theodorakis, PT
• Andrea Theodoru, MD
• Therapedia, LLC
• Therapy Medical-Wellness Centers, LLC
• Therapy Works,P.C.
• Therapyzone, LLC
• Joan Thiel

• Obstetrics & Gynecology Physician in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Obstetrics & Gynecology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.