MEDICARE: ASMA EOBAL ALI M.D.

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	207Q00000X	Family Medicine Physician	055467	GA

General Provider Information

NPI Number	:	1497737936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASMA EOBAL ALI M.D.

Provider Business Mailing Address
First Line	:	2032 WYNNTON RD
Second Line	:	SUITE B
City	:	COLUMBUS
State	:	GA
Zip	:	31906-2448
Country	:	US
Telephone Number	:	706-660-8505
Fax Number	:	706-660-9390

Provider Business Practice Location Address
First Line	:	2032 WYNNTON RD
Second Line	:	SUITE B
City	:	COLUMBUS
State	:	GA
Zip	:	31906-2448
Country	:	US
Telephone Number	:	706-320-0518
Fax Number	:	706-324-7585

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	03/04/2008

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