MEDICARE: ALI ANNAIM

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	2080P0210X	Pediatric Nephrology Physician	MD86545	SC
2	390200000X	Student in an Organized Health Care Education/Training Program	APPLIED FOR	IN
3	2080P0210X	Pediatric Nephrology Physician	80336	GA

General Provider Information

NPI Number	:	1861887259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALI ANNAIM

Provider Business Mailing Address
First Line	:	2174 N DRUID HILLS RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 DOUGHTY STREET
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8630
Country	:	US
Telephone Number	:	843-792-8904
Fax Number	:

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

Provider Enumeration Date	:	04/02/2015
Last Update Date	:	08/18/2025

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Directions to “ ALI ANNAIM ” Practice Location

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