Provider Demographics
NPI:1205575180
Name:SUBOH, ALHASSAN SAMEH (FNP)
Entity type:Individual
Prefix:
First Name:ALHASSAN
Middle Name:SAMEH
Last Name:SUBOH
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6027 WALNUT GROVE RD STE 307
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2128
Mailing Address - Country:US
Mailing Address - Phone:901-425-3200
Mailing Address - Fax:901-682-7737
Practice Address - Street 1:6027 WALNUT GROVE RD STE 307
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2128
Practice Address - Country:US
Practice Address - Phone:901-425-3200
Practice Address - Fax:901-682-7737
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31717363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner