MEDICARE: DR. AHMAD H ALTABBAA 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	207P00000X	Emergency Medicine Physician	27191	TN
2	207R00000X	Internal Medicine Physician	27191	TN

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

General Provider Information

NPI Number	:	1952350233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AHMAD H ALTABBAA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3836
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38088-3836
Country	:	US
Telephone Number	:	901-791-2764
Fax Number	:	901-791-2783

Provider Business Practice Location Address
First Line	:	3950 NEW COVINGTON PIKE
Second Line	:	SUITE 290
City	:	MEMPHIS
State	:	TN
Zip	:	38128-2595
Country	:	US
Telephone Number	:	901-791-2764
Fax Number	:	901-791-2783

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

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	01/18/2012

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