Provider Demographics
NPI:1063508810
Name:ALI, MUHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
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 1:2311 HENRY CLOWER BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2666
Mailing Address - Country:US
Mailing Address - Phone:770-982-0255
Mailing Address - Fax:770-982-0251
Practice Address - Street 1:2311 HENRY CLOWER BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2666
Practice Address - Country:US
Practice Address - Phone:770-982-0255
Practice Address - Fax:770-982-0251
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0397182080I0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080I0007XAllopathic & Osteopathic PhysiciansPediatricsClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA01000295Medicaid
GA00655366CMedicaid
GA319384Medicaid