Provider Demographics
NPI:1811905409
Name:ALI, FATHI IDRIS (MD)
Entity type:Individual
Prefix:
First Name:FATHI
Middle Name:IDRIS
Last Name:ALI
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 1:854 W JAMES CAMPBELL BLVD
Mailing Address - Street 2:SUITE 303 A
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4659
Mailing Address - Country:US
Mailing Address - Phone:931-540-4255
Mailing Address - Fax:931-540-4218
Practice Address - Street 1:1220 TROTWOOD AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6433
Practice Address - Country:US
Practice Address - Phone:931-388-8622
Practice Address - Fax:931-381-7270
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44108207RC0001X, 207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4204226OtherBCBST
TN3379860Medicaid
TN1509829Medicaid
GA06CBBCGOtherMEDICARE #
GA06CBBCGOtherMEDICARE #
TN3379860Medicaid
TN1509829Medicaid
TN3002446Medicare PIN