MEDICARE: MEND PRIMARY CARE LLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1457131526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEND PRIMARY CARE LLC

Provider Business Mailing Address
First Line	:	2256 NORTHLAKE PKWY STE 204A
Second Line	:
City	:	TUCKER
State	:	GA
Zip	:	30084-4004
Country	:	US
Telephone Number	:	770-676-5602
Fax Number	:	470-906-0391

Provider Business Practice Location Address
First Line	:	1936 N DRUID HILLS RD NE STE A
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30319-4131
Country	:	US
Telephone Number	:	770-676-5602
Fax Number	:	470-906-0391

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. TEWODROS ALEMU
Credential	:	MD
Telephone Number	:	770-676-5602

Provider Enumeration Date	:	10/04/2023
Last Update Date	:	05/29/2026

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