MEDICARE: MARKO OSSAMA GHALI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	6435	TN
2	363A00000X	Physician Assistant	25MP00961000	NJ

General Provider Information

NPI Number	:	1790581486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARKO OSSAMA GHALI

Provider Business Mailing Address
First Line	:	2163 CAREFREE LN
Second Line	:
City	:	ANTIOCH
State	:	TN
Zip	:	37013-3586
Country	:	US
Telephone Number	:	615-873-9893
Fax Number	:

Provider Business Practice Location Address
First Line	:	890 ISABELLA LN
Second Line	:
City	:	SMYRNA
State	:	TN
Zip	:	37167-4215
Country	:	US
Telephone Number	:	615-768-8021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2025
Last Update Date	:	04/07/2026

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Directions to “ MARKO OSSAMA GHALI ” Practice Location

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