Healthcare Provider Details

I. General information

NPI: 1912084617
Provider Name (Legal Business Name): AYSEL ATLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/15/2022
Certification Date: 01/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 HEALTH PARK STE 109
RALEIGH NC
27615
US

IV. Provider business mailing address

8300 HEALTH PARK STE 109
RALEIGH NC
27615-4731
US

V. Phone/Fax

Practice location:
  • Phone: 612-999-7759
  • Fax:
Mailing address:
  • Phone: 919-322-2064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2010-01166
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number2010-01166
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number2010-01166
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: