Thanmayie Bethi
Individual provider Active NPI Family Nurse Practitioner · Clarkston, GA
NPI 1962038307 · NPPES record last updated Aug 15, 2026
Key facts
- NPI
- 1962038307
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 246736 (GA)
- Practice address
- 4112 E Ponce de Leon Ave
Clarkston, GA 30021-8106 - Phone
- (404) 296-7133
- NPI assigned
- Mar 17, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Philadelphia Col of Osteo Med, Sewanee, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Qcpi-Villagemd PC
Practice addresses (Care Compare)
1625 Ridenour Blvd NW
Suite 305
Kennesaw, GA 30152-4467
Phone (470) 681-9400
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221018001398 | GA | Practitioner - Nurse Practitioner | 4880060771 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 246736 | GA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Qcpi-Villagemd, PC | Current |
Accepting new patients | |
| MC Medical LLC | Current | Accepting new patients |
Locations
702 SW 8th St
Bentonville, AR 72716
3615 Charles Hardy Pkwy
Ste 200
Dallas, GA 30157
Phone (770) 767-5542
1619 Ridenour Blvd NW
Ste 305
Kennesaw, GA 30152
1625 Ridenour Blvd NW
Ste 305
Kennesaw, GA 30152
Phone (470) 826-5015
1805 Parke Plaza Cir
Ste 101
Stone Mtn, GA 30087
Phone (770) 469-7000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 246736 | GA | Yes |
Addresses
Primary practice location
4112 E Ponce de Leon Ave
Clarkston, GA 30021-8106
Mailing address
1124 N Tennessee St Ste 104
Cartersville, GA 30120-7938
Phone (847) 420-1233
Other providers in Clarkston, GA
- Fresew Assefa
- Abel Aung
- Zewdie Chanyalew Ayenew
- Bella Dental Services, P.C
- Best Care Dental Inc.
- Istiaque Biswas
- Bliss Primary and Urgent Care PC
- William Bodnar
- Courtney S Bowman
- Devonee Marie Boydston
All providers in Clarkston, GA · Family Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 15, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.