Healthcare Provider Details

I. General information

NPI: 1063407534
Provider Name (Legal Business Name): MOHAMMAD A ALSOUB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HIGHWAY 70 E STE 102
DICKSON TN
37055-2080
US

IV. Provider business mailing address

127 CRESTVIEW PARK DR STE 209
DICKSON TN
37055-2856
US

V. Phone/Fax

Practice location:
  • Phone: 615-375-1531
  • Fax: 615-375-1526
Mailing address:
  • Phone: 615-446-5121
  • Fax: 615-446-1359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number38437
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number38437
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: