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General NPI Number Information
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NPI Number | 1811905409
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Entity Type | Individual
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Provider Name | FATHI IDRIS ALI M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 01/07/2022
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Provider Practice Location Address
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Address Line | 1220 TROTWOOD AVE SUITE 401
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City | COLUMBIA
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State | TN
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Zip | 38401-6433
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Country | US
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Telephone | 931-388-8622
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Fax | 931-381-7270
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Provider Business Mailing Address
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Address Line | 854 W JAMES CAMPBELL BLVD SUITE 303 A
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City | COLUMBIA
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State | TN
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Zip | 38401-4659
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Country | US
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Telephone | 931-540-4255
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Fax | 931-540-4218
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | 44108
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 44108
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 44108
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License Number State | TN
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