Provider Demographics
NPI:1639125560
Name:ALKAYYALI, FAWWAZ A (MD)
Entity Type:Individual
Prefix:
First Name:FAWWAZ
Middle Name:A
Last Name:ALKAYYALI
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:PO BOX 110925
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37222-0925
Mailing Address - Country:US
Mailing Address - Phone:615-781-1935
Mailing Address - Fax:615-781-1936
Practice Address - Street 1:393 WALLACE RD STE A302
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4983
Practice Address - Country:US
Practice Address - Phone:615-781-1935
Practice Address - Fax:615-781-1936
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27572207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4024735OtherBCBST
AL009975320Medicaid
TN3731879OtherMEDICARE PIN
AL009941739Medicaid
TN3097985Medicaid
TN3097984OtherMEDICAID PIN
AL890-12152OtherBCBSAL
TN4024735OtherBCBS
TNP00403756OtherRAILROAD
TN4024735OtherBCBSTN
TN4024735OtherBCBST
TN3097985Medicaid
AL890-12152OtherBCBSAL
3097985Medicare PIN