Provider Demographics
NPI:1497361414
Name:ALALIM, QADRIYYAH TAHEERAH (NP)
Entity Type:Individual
Prefix:
First Name:QADRIYYAH
Middle Name:TAHEERAH
Last Name:ALALIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:QADRIYYAH
Other - Middle Name:T
Other - Last Name:AL-ALIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:PARROTT
Mailing Address - State:GA
Mailing Address - Zip Code:39877-0156
Mailing Address - Country:US
Mailing Address - Phone:678-879-9249
Mailing Address - Fax:
Practice Address - Street 1:504 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31705-2717
Practice Address - Country:US
Practice Address - Phone:229-500-2329
Practice Address - Fax:229-500-4891
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN163976207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine