MEDICARE: MRS. ZEWDI TESFAMICHAEL PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN-NP298968	GA

General Provider Information

NPI Number	:	1427914373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ZEWDI TESFAMICHAEL PMHNP-BC

Provider Business Mailing Address
First Line	:	1330 KILLIAN SHOALS WAY SW
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-7606
Country	:	US
Telephone Number	:	404-510-2086
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 KILLIAN SHOALS WAY SW
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-7606
Country	:	US
Telephone Number	:	404-510-2086
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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