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NPI Code Detail

MEDICARE: FATHI IDRIS ALI M.D.

MEDICARE: FATHI IDRIS 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
1207RC0001XClinical Cardiac Electrophysiology Physician44108TN
2207RI0011XInterventional Cardiology Physician44108TN
3207RC0000XCardiovascular Disease Physician44108TN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
406CBBCGOTHERGAMEDICARE #

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14204226OTHERTNBCBST
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811905409
Entity Type Code : Individual
Provider Name (Legal Business Name) : FATHI IDRIS ALI M.D.
Provider Business Mailing Address
First Line : 854 W JAMES CAMPBELL BLVD
Second Line : SUITE 303 A
City : COLUMBIA
State : TN
Zip : 38401-4659
Country : US
Telephone Number : 931-540-4255
Fax Number : 931-540-4218
Provider Business Practice Location Address
First Line : 1220 TROTWOOD AVE
Second Line : SUITE 401
City : COLUMBIA
State : TN
Zip : 38401-6433
Country : US
Telephone Number : 931-388-8622
Fax Number : 931-381-7270
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2006
Last Update Date : 01/07/2022

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