Provider Demographics
NPI:1720211675
Name:AL-FAKHOURI, AHMAD ABDUL GHAFFAR A (MD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:ABDUL GHAFFAR A
Last Name:AL-FAKHOURI
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 27169
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38167-0169
Mailing Address - Country:US
Mailing Address - Phone:708-980-3117
Mailing Address - Fax:901-377-3633
Practice Address - Street 1:325 FLEETS HILL DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-5207
Practice Address - Country:US
Practice Address - Phone:708-890-3117
Practice Address - Fax:901-377-3633
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48952207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine