MEDICARE: MUSTAFA 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	207L00000X	Anesthesiology Physician	87561	GA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207L00000X	Anesthesiology Physician	0101271369	VA

General Provider Information

NPI Number	:	1699041004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUSTAFA ALI M.D.

Provider Business Mailing Address
First Line	:	1440 COLUMBIA ST APT 1210
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-3473
Country	:	US
Telephone Number	:	703-798-2193
Fax Number	:

Provider Business Practice Location Address
First Line	:	1365 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30368-1716
Country	:	US
Telephone Number	:	404-712-2000
Fax Number	:

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

Provider Enumeration Date	:	03/29/2012
Last Update Date	:	02/12/2025

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