Provider Demographics
NPI:1235177072
Name:ALI, KAREEM U (MD)
Entity Type:Individual
Prefix:
First Name:KAREEM
Middle Name:U
Last Name:ALI
Suffix:
Gender:F
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 769609
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-8224
Mailing Address - Country:US
Mailing Address - Phone:770-938-1266
Mailing Address - Fax:770-939-4093
Practice Address - Street 1:2362 MAIN ST
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4477
Practice Address - Country:US
Practice Address - Phone:770-938-1266
Practice Address - Fax:770-939-4093
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037742207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000581809HMedicaid
GA000581809GMedicaid
GA000581809IMedicaid
GA000581809KMedicaid
GA000581809GMedicaid
C41287Medicare UPIN