Individual
MR. HAILU M KEBEDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2015 RANDOLPH RD STE 208, CHARLOTTE, NC 28207-1200
(704) 377-4009
Mailing address
13808 PROFESSIONAL CENTER DR, HUNTERSVILLE, NC 28078-7948
(704) 377-4009
(704) 602-6563
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001010441
NC
363A00000X
Physician Assistant
1817
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1817
LICENSE
SC
Enumeration date
08/27/2012
Last updated
02/05/2025
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