MEDICARE: HAILEGIORGIS A WOLDEGIORGIS 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	208M00000X	Hospitalist Physician	Q4344	TX
2	207R00000X	Internal Medicine Physician	Q4344	TX

General Provider Information

NPI Number	:	1841559309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAILEGIORGIS A WOLDEGIORGIS MD

Provider Business Mailing Address
First Line	:	5872 OLD JACKSONVILLE HWY
Second Line	:	APT # 618
City	:	TYLER
State	:	TX
Zip	:	75703-0626
Country	:	US
Telephone Number	:	510-712-3007
Fax Number	:

Provider Business Practice Location Address
First Line	:	5872 OLD JACKSONVILLE HWY
Second Line	:	APT # 618
City	:	TYLER
State	:	TX
Zip	:	75703-0626
Country	:	US
Telephone Number	:	510-712-3007
Fax Number	:

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

Provider Enumeration Date	:	05/03/2012
Last Update Date	:	06/13/2024

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