Provider Demographics
NPI:1437210358
Name:WOLDEHAWARIAT, NEGA (MD)
Entity type:Individual
Prefix:DR
First Name:NEGA
Middle Name:
Last Name:WOLDEHAWARIAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1668 MULKEY RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1143
Mailing Address - Country:US
Mailing Address - Phone:770-944-8494
Mailing Address - Fax:678-945-7401
Practice Address - Street 1:1668 MULKEY RD
Practice Address - Street 2:STE G
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1143
Practice Address - Country:US
Practice Address - Phone:770-944-8494
Practice Address - Fax:678-945-7401
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAC051570207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000977347( I )Medicaid
GAGRP6502Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
GA39BDCJH 176973#Medicare ID - Type UnspecifiedMEDICAR PROVIDER NUMBER
GA000977347( I )Medicaid