Provider Demographics
NPI:1982685244
Name:ALI, SYED SHAUKAT (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:SHAUKAT
Last Name:ALI
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 1:2032 WYNNTON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-2448
Mailing Address - Country:US
Mailing Address - Phone:706-320-9355
Mailing Address - Fax:706-324-7585
Practice Address - Street 1:2032 WYNNTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-2448
Practice Address - Country:US
Practice Address - Phone:706-320-9355
Practice Address - Fax:706-324-7585
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0358012080P0206X
AL000207562080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F87762Medicare UPIN