Healthcare Provider Details

I. General information

NPI: 1558464503
Provider Name (Legal Business Name): HAILE M MEZGHEBE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3443 DICKERSON PIKE STE 370
NASHVILLE TN
37207-2535
US

IV. Provider business mailing address

3443 DICKERSON PIKE STE 370
NASHVILLE TN
37207-2535
US

V. Phone/Fax

Practice location:
  • Phone: 615-769-2799
  • Fax: 615-769-2798
Mailing address:
  • Phone: 615-769-2799
  • Fax: 615-769-2798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number50324
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD14740
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: