Provider Demographics
NPI:1801025788
Name:TEFERA, TIBEBU TSEHAY (MD)
Entity Type:Individual
Prefix:DR
First Name:TIBEBU
Middle Name:TSEHAY
Last Name:TEFERA
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 1:501 REDMOND RD NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1415
Mailing Address - Country:US
Mailing Address - Phone:706-368-8452
Mailing Address - Fax:706-368-8453
Practice Address - Street 1:501 REDMOND RD
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165
Practice Address - Country:US
Practice Address - Phone:706-368-8452
Practice Address - Fax:706-368-8453
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003697207R00000X
GA067810207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine