Provider Demographics
NPI:1588677678
Name:ATYIA, ATIF A (MD)
Entity Type:Individual
Prefix:
First Name:ATIF
Middle Name:A
Last Name:ATYIA
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 1:1003 E JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-1538
Mailing Address - Country:US
Mailing Address - Phone:423-753-6077
Mailing Address - Fax:423-753-8788
Practice Address - Street 1:1003 E JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-1538
Practice Address - Country:US
Practice Address - Phone:423-753-6077
Practice Address - Fax:423-753-8788
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD30739207Q00000X, 207R00000X, 208000000X
TN30739207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1588677678Medicaid
TN3874724Medicaid
TN103I113716Medicare PIN
H48896Medicare UPIN
VA1588677678Medicaid