Provider Demographics
NPI:1891854725
Name:ALI, NADIA (PHD)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:ALI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 N DECATUR RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5307
Mailing Address - Country:US
Mailing Address - Phone:404-778-8613
Mailing Address - Fax:404-778-8562
Practice Address - Street 1:2165 N DECATUR RD
Practice Address - Street 2:EMORY DEPT OF HUMAN GENETICS
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5307
Practice Address - Country:US
Practice Address - Phone:404-778-8613
Practice Address - Fax:404-778-8562
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002548103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q25183Medicare UPIN
68BBGKTMedicare ID - Type Unspecified