Provider Demographics
NPI:1780779751
Name:ALJAMAL, EYAD K (MD)
Entity type:Individual
Prefix:MR
First Name:EYAD
Middle Name:K
Last Name:ALJAMAL
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:PO BOX 1220
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38557
Mailing Address - Country:US
Mailing Address - Phone:931-456-6700
Mailing Address - Fax:931-456-8008
Practice Address - Street 1:320 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555
Practice Address - Country:US
Practice Address - Phone:931-456-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD34139207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3851666Medicaid
TN4033314OtherBCBS
TN3851666Medicaid
TN3851666Medicare Oscar/Certification
TN3851666Medicare PIN