Provider Demographics
NPI:1114984267
Name:HAGGERSON, GEORGE WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WILLIAM
Last Name:HAGGERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3318 HEALY DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1404
Mailing Address - Country:US
Mailing Address - Phone:336-768-7500
Mailing Address - Fax:336-768-2421
Practice Address - Street 1:3318 HEALY DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1404
Practice Address - Country:US
Practice Address - Phone:336-768-7500
Practice Address - Fax:336-768-2421
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2007-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30914208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8938079Medicaid
NC206912AMedicare ID - Type Unspecified
NCC84252Medicare UPIN