Provider Demographics
NPI:1235175571
Name:MEMON, ALI MUHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:MUHAMMAD
Last Name:MEMON
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 1:485 VILLA PLACE CT
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-1958
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2660 SATELLITE BLVD
Practice Address - Street 2:CHILDREN'S HEALTH CARE OF ATLANTA
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5803
Practice Address - Country:US
Practice Address - Phone:404-785-8330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042359208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics