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General NPI Number Information
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NPI Number | 1881819712
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Entity Type | Organization
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Legal Business Name | TSION HAILESELASSIE, MD, PA, D.B.A GAINESVILLE PEDIATRICS
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 06/18/2013
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Provider Practice Location Address
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Address Line | 426 N GRAND AVE
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City | GAINESVILLE
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State | TX
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Zip | 76240-4324
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Country | US
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Telephone | 940-665-9915
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Fax | 940-665-9962
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Provider Business Mailing Address
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Address Line | 426 N GRAND AVE
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City | GAINESVILLE
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State | TX
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Zip | 76240-4324
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Country | US
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Telephone | 940-665-9915
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Fax | 940-665-9962
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. TSION ELAINE HAILESELASSIE
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Credential | M.D.
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Telephone | 940-665-9915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | L5755
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License Number State | TX
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