Provider Demographics
NPI:1134386592
Name:ABDUS-SALAAM, SHARIF ASHANTI (MD)
Entity type:Individual
Prefix:DR
First Name:SHARIF
Middle Name:ASHANTI
Last Name:ABDUS-SALAAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1264 WESLEY DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-6400
Mailing Address - Country:US
Mailing Address - Phone:901-260-2072
Mailing Address - Fax:901-260-2077
Practice Address - Street 1:6518 GOODMAN RD STE 104
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-9809
Practice Address - Country:US
Practice Address - Phone:662-420-7350
Practice Address - Fax:662-534-2330
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA108853207X00000X
TN45803207X00000X
MS21698207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA108853OtherCALIFORNIA LIC #
TN45803OtherTN MEDICAL LICENSE NUMBER
CACJ428ZMedicare PIN