=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386305993
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | QANI ISMAIL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2022
-----------------------------------------------------
Last Update Date | 01/26/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1040 MURFREESBORO PIKE STE 105
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37217-1538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-900-5599
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1040 MURFREESBORO PIKE STE 105
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37217-1538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-900-5599
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 342000000X
-----------------------------------------------------
Taxonomy Name | Transportation Network Company
-----------------------------------------------------
License Number | 222925
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------