Healthcare Provider Details

I. General information

NPI: 1669376638
Provider Name (Legal Business Name): ISRA AHMED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1195 POPLAR AVE
MEMPHIS TN
38105-4807
US

IV. Provider business mailing address

3625 COBB RD
LAKELAND TN
38002-9709
US

V. Phone/Fax

Practice location:
  • Phone: 901-722-8445
  • Fax:
Mailing address:
  • Phone: 901-504-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13327
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: