Provider Demographics
NPI:1609031566
Name:SHIFA AL ASQAM MEDICAL CENTER
Entity Type:Organization
Organization Name:SHIFA AL ASQAM MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEVORN
Authorized Official - Middle Name:
Authorized Official - Last Name:ASKARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-687-3351
Mailing Address - Street 1:PO BOX 170560
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-0560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:540 FAYETTEVILLE RD SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-2306
Practice Address - Country:US
Practice Address - Phone:404-964-0960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty