MEDICARE: DR. MOHAMMED TAHER AL-TAHER I MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	41183	TN
2	2084P0800X	Psychiatry Physician	E3044	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11591588	OTHER		CAQH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235107368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMED TAHER AL-TAHER I MD

Provider Business Mailing Address
First Line	:	1176 VICKERY LN STE 100
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38016-0631
Country	:	US
Telephone Number	:	901-737-1992
Fax Number	:	901-309-8784

Provider Business Practice Location Address
First Line	:	3173 KIRBY WHITTEN RD STE 104
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38134-2881
Country	:	US
Telephone Number	:	901-380-8040
Fax Number	:	901-309-8784

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	10/02/2020

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