Provider Demographics
NPI:1700873049
Name:ALI, SUBHI D (MD FACS)
Entity Type:Individual
Prefix:DR
First Name:SUBHI
Middle Name:D
Last Name:ALI
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:806 E MAIN ST
Mailing Address - Street 2:PO BOX 786
Mailing Address - City:WAVERLY
Mailing Address - State:TN
Mailing Address - Zip Code:37185-1814
Mailing Address - Country:US
Mailing Address - Phone:931-296-7788
Mailing Address - Fax:931-296-7130
Practice Address - Street 1:806 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-1814
Practice Address - Country:US
Practice Address - Phone:931-296-7788
Practice Address - Fax:931-296-7130
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000009598208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN142928OtherBLUE CROSS
TN1740209OtherUNITED HEALTHCARE
TN3161153Medicaid
TN142928OtherBLUE CROSS
TN3161153Medicare ID - Type Unspecified