MEDICARE: ZAHER AL-SHALLAH 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	207RN0300X	Nephrology Physician	46930	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	1031396319	OTHER	TN	MEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number	:	1356399117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZAHER AL-SHALLAH MD

Provider Business Mailing Address
First Line	:	PO BOX 847
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38088-0847
Country	:	US
Telephone Number	:	901-888-4144
Fax Number	:	901-328-1450

Provider Business Practice Location Address
First Line	:	7710 WOLF RIVER CIR
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38138-1734
Country	:	US
Telephone Number	:	901-888-4144
Fax Number	:

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	09/19/2023

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Directions to “ ZAHER AL-SHALLAH MD” Practice Location

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