Healthcare Provider Details

I. General information

NPI: 1174699516
Provider Name (Legal Business Name): MEMPHIS INTERNIST, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3294 POPLAR AVE SUITE 100
MEMPHIS TN
38111-4649
US

IV. Provider business mailing address

3294 POPLAR AVE SUITE 100
MEMPHIS TN
38111-4649
US

V. Phone/Fax

Practice location:
  • Phone: 901-362-8671
  • Fax:
Mailing address:
  • Phone: 901-362-8671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MAHMOOD ALI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 901-362-8671