Provider Demographics
NPI:1548339617
Name:ABDULAHI, FETHI
Entity type:Individual
Prefix:
First Name:FETHI
Middle Name:
Last Name:ABDULAHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5045 OLD HICKORY BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HERNITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076
Mailing Address - Country:US
Mailing Address - Phone:615-690-7029
Mailing Address - Fax:615-690-7028
Practice Address - Street 1:314 NORTHCREST DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172
Practice Address - Country:US
Practice Address - Phone:615-382-0700
Practice Address - Fax:615-382-0790
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNO132751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA251570527AMedicaid