Provider Demographics
NPI:1841559309
Name:WOLDEGIORGIS, HAILEGIORGIS A (MD)
Entity Type:Individual
Prefix:
First Name:HAILEGIORGIS
Middle Name:A
Last Name:WOLDEGIORGIS
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 1:5872 OLD JACKSONVILLE HWY
Mailing Address - Street 2:APT # 618
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0626
Mailing Address - Country:US
Mailing Address - Phone:510-712-3007
Mailing Address - Fax:
Practice Address - Street 1:5872 OLD JACKSONVILLE HWY
Practice Address - Street 2:APT # 618
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0626
Practice Address - Country:US
Practice Address - Phone:510-712-3007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ4344208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist