Provider Demographics
NPI:1164468468
Name:ALI, JEFFREY ASGAR (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ASGAR
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 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-6925
Mailing Address - Fax:601-984-5842
Practice Address - Street 1:3450 HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209-7201
Practice Address - Country:US
Practice Address - Phone:601-321-2400
Practice Address - Fax:601-985-5174
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS140672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS260044395OtherPALMETTO GBA-RAILROAD MED
MSP00649222OtherMEDICARE RR
MS00114335Medicaid
MSP01402415OtherRR MEDICARE
MS302I265634Medicare PIN
MS512I260006Medicare PIN
MSP00649222OtherMEDICARE RR