Provider Demographics
NPI:1972267342
Name:ALI, SAMEER (PA-C)
Entity Type:Individual
Prefix:
First Name:SAMEER
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4835 SUGARLOAF PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-6916
Mailing Address - Country:US
Mailing Address - Phone:770-656-7621
Mailing Address - Fax:
Practice Address - Street 1:4835 SUGARLOAF PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-6916
Practice Address - Country:US
Practice Address - Phone:470-375-5940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA1177337363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical