Provider Demographics
NPI:1518918937
Name:ALI, MAHMOOD (MD)
Entity type:Individual
Prefix:
First Name:MAHMOOD
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 383377
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-3377
Mailing Address - Country:US
Mailing Address - Phone:901-362-8671
Mailing Address - Fax:901-405-0365
Practice Address - Street 1:3021 BRUNSWICK RD STE 1105
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4198
Practice Address - Country:US
Practice Address - Phone:901-362-8671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000030021207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ011106Medicaid
MS00125928Medicaid
TN3832363Medicaid
TNG46534Medicare UPIN