Healthcare Provider Details

I. General information

NPI: 1538276704
Provider Name (Legal Business Name): ADULT AND ADOLESCENT MEDICINE CLINICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 BRUNSWICK RD STE 1105
MEMPHIS TN
38133-4198
US

IV. Provider business mailing address

PO BOX 383377
GERMANTOWN TN
38183-3377
US

V. Phone/Fax

Practice location:
  • Phone: 901-362-8671
  • Fax: 901-405-0365
Mailing address:
  • Phone: 901-726-3979
  • 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: MAHMOOD ALI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 901-726-3979