Provider Demographics
NPI:1205975075
Name:MAHMOOD 'TONY' ALI, MD
Entity type:Organization
Organization Name:MAHMOOD 'TONY' ALI, MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOOD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-362-8671
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT 583
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-362-8671
Mailing Address - Fax:901-458-4896
Practice Address - Street 1:3294 POPLAR AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4649
Practice Address - Country:US
Practice Address - Phone:901-362-8671
Practice Address - Fax:901-458-4896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000030021207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3832363Medicaid
MS00125928Medicaid
TN3832363Medicaid
MS00125928Medicaid