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1356401616

NPI Code Detail

MEDICARE: HAILU DEMISSACHEW MD

MEDICARE: HAILU DEMISSACHEW MD

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	207RN0300X	Nephrology Physician	054072	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356401616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAILU DEMISSACHEW MD

Provider Business Mailing Address
First Line	:	221 TECHNOLOGY PKWY NW
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30165-1369
Country	:	US
Telephone Number	:	762-235-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 REDMOND RD NW
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30165-1533
Country	:	US
Telephone Number	:	706-233-8504
Fax Number	:	706-233-8505

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

Provider Enumeration Date	:	12/09/2006
Last Update Date	:	03/23/2020

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Directions to “ HAILU DEMISSACHEW MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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