Healthcare Provider Details

I. General information

NPI: 1003436783
Provider Name (Legal Business Name): ALI KASSEM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date: 01/10/2022
Reactivation Date: 02/08/2022

III. Provider practice location address

275 COLLIER RD NW STE 300
ATLANTA GA
30309-1740
US

IV. Provider business mailing address

475 SEAVIEW UNIVERSITY, STATEN ISLAND, NEW YORK STATEN ISLAND UNIVERSITY HOSPITAL, DEPARTMENT OF INTERN
STATEN ISLAND, NYC NY
10305
US

V. Phone/Fax

Practice location:
  • Phone: 404-350-0009
  • Fax:
Mailing address:
  • Phone: 718-226-8855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number110869
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: