Healthcare Provider Details

I. General information

NPI: 1114868593
Provider Name (Legal Business Name): SALAMAT ALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

1704 HIGHWAY 35 N
FOREST MS
39074-9649
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5426
  • Fax:
Mailing address:
  • Phone: 601-504-2535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: