Provider Demographics
NPI:1780784454
Name:ALI, NASIRA R (MD)
Entity type:Individual
Prefix:DR
First Name:NASIRA
Middle Name:R
Last Name:ALI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1805 HERRINGTON RD
Mailing Address - Street 2:BLDG. 1 SUITE A
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-7987
Mailing Address - Country:US
Mailing Address - Phone:678-226-2295
Mailing Address - Fax:678-226-2296
Practice Address - Street 1:1805 HERRINGTON RD
Practice Address - Street 2:BLDG. 1 SUITE A
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-7987
Practice Address - Country:US
Practice Address - Phone:678-226-2295
Practice Address - Fax:678-226-2296
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0566422084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA638411026BMedicaid
GA648074039AMedicaid
GA638411026AMedicaid