Healthcare Provider Details

I. General information

NPI: 1457849333
Provider Name (Legal Business Name): MICHAEL SOLOMON ASSEFA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 S 28TH AVE
HATTIESBURG MS
39401-7246
US

IV. Provider business mailing address

1682 POTTSBURG POINT DR
JACKSONVILLE FL
32207-2488
US

V. Phone/Fax

Practice location:
  • Phone: 601-288-4329
  • Fax: 601-579-5240
Mailing address:
  • Phone: 408-568-8584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMD21167
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number36603
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number1912-320
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number87671
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: