MEMORIAL DRIVE FAMILY MEDICINE P.C
NPI 1285994251
Family Medicine in Stone Mountain, GA

Q: What is Memorial Drive Family Medicine P.C's NPI number?

The NPI number for Memorial Drive Family Medicine P.C is 1285994251. It was assigned to this organization in the NPPES registry on May 23, 2012.

Q: What is Memorial Drive Family Medicine P.C's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Active since May 23, 2012CLIA 11D2043038 · Waiver

4958 MEMORIAL DR, STONE MOUNTAIN, GA 30083(404) 809-2480(404) 809-2485 Get Directions Write a Review

NPPES record last updated: July 12, 2012. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Memorial Drive Family Medicine P.c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MEMORIAL DRIVE FAMILY MEDICINE P.C (NPI 1285994251) is a healthcare organization registered as a family medicine in Stone Mountain, Georgia and active in the NPI registry since May 2012. The organization holds a CLIA Waiver certificate valid through June 25, 2028 and lists Tassew Tesfaye, Medical Doctor, as its authorized official.

NPPES Registry Identity

NPI1285994251

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameMEMORIAL DRIVE FAMILY MEDICINE P.C

Location Address4958 MEMORIAL DRStone Mountain, GA 30083-4148

Mailing Address4958 Memorial DrStone Mountain, GA 30083-4148 · (404) 809-2480 · Fax (404) 809-2485

Phone(404) 809-2480

Fax(404) 809-2485

Organization SubpartNo

Authorized OfficialTassew TesfayeMedical Doctor · (404) 809-2480

Enumeration DateMay 23, 2012

Last NPPES UpdateJuly 12, 2012

✔ NPI 1285994251 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

4958 MEMORIAL DR, Stone Mountain, GA 30083

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Memorial Drive Family Medicine P.c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Memorial Drive Family Medicine P.C, which bills Medicare for the services this clinician delivers.

Clinician (1)

Tassew Tesfaye, M.D.

Family Practice

NPI 1710974696

4958 MEMORIAL DR
Stone Mountain, GA 30083

(404) 809-2480

✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2043038

Memorial Drive Family Medical PC · Stone Mountain, GA

Active · expires Jun 25, 2028

CLIA Number11D2043038

Laboratory TypePhysician Office

Certificate Effective DateJune 26, 2026

Certificate Expiration DateJune 25, 2028

Laboratory DirectorDr. Tassew Testaye

Laboratory Phone(404) 809-2480

Laboratory LocationMemorial Drive Family Medical PC4958 Memorial Drive, Stone Mountain, GA 30083

CLIA data matches this NPI record on: Address Phone

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Memorial Drive Family Medicine P.C's NPI number?

The NPI number for Memorial Drive Family Medicine P.C is 1285994251. It was assigned to this organization in the NPPES registry on May 23, 2012.

Where is Memorial Drive Family Medicine P.C located?

Memorial Drive Family Medicine P.C is located at 4958 Memorial Dr, Stone Mountain, GA 30083. The listed phone number is (404) 809-2480.

What is Memorial Drive Family Medicine P.C's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Memorial Drive Family Medicine P.C enrolled in Medicare?

Yes. Memorial Drive Family Medicine P.C is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Memorial Drive Family Medicine P.C?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Memorial Drive Family Medicine P.C. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Memorial Drive Family Medicine P.C hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2043038) is associated with this NPI, valid through June 25, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Memorial Drive Family Medicine P.C accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Memorial Drive Family Medicine P.C as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Memorial Drive Family Medicine P.C was last updated on July 12, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.