Provider Demographics
NPI:1497737936
Name:ALI, ASMA EOBAL (MD)
Entity Type:Individual
Prefix:
First Name:ASMA
Middle Name:EOBAL
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 1:2032 WYNNTON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-2448
Mailing Address - Country:US
Mailing Address - Phone:706-660-8505
Mailing Address - Fax:706-660-9390
Practice Address - Street 1:2032 WYNNTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-2448
Practice Address - Country:US
Practice Address - Phone:706-320-0518
Practice Address - Fax:706-324-7585
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA055467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08BBRSHMedicare PIN
I26185Medicare UPIN
GAGRP7007Medicare PIN