Healthcare Provider Details

I. General information

NPI: 1205975075
Provider Name (Legal Business Name): MAHMOOD 'TONY' ALI, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/24/2007
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

PO BOX 1000 DEPT 583
MEMPHIS TN
38148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 901-362-8671
  • Fax: 901-458-4896
Mailing address:
  • Phone: 901-362-8671
  • Fax: 901-458-4896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD0000030021
License Number StateTN

VIII. Authorized Official

Name: MAHMOOD ALI
Title or Position: PRESIDENT
Credential: MD
Phone: 901-362-8671