MEDICARE: SHIFA AL ASQAM MEDICAL CENTER

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	174400000X	Specialist

General Provider Information

NPI Number	:	1609031566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIFA AL ASQAM MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 170560
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30317-0560
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	540 FAYETTEVILLE RD SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-2306
Country	:	US
Telephone Number	:	404-964-0960
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NEVORN ASKARI
Credential	:	M.D.
Telephone Number	:	404-687-3351

Provider Enumeration Date	:	07/21/2008
Last Update Date	:	07/21/2008

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