Individual
FATHI IDRIS ALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1220 TROTWOOD AVE, SUITE 401, COLUMBIA, TN 38401-6433
(931) 388-8622
(931) 381-7270
Mailing address
854 W JAMES CAMPBELL BLVD, SUITE 303 A, COLUMBIA, TN 38401-4659
(931) 540-4255
(931) 540-4218
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
44108
TN
207RC0001X
Clinical Cardiac Electrophysiology Physician
44108
TN
207RI0011X
Interventional Cardiology Physician
44108
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06CBBCG
MEDICARE #
GA
05
—
1509829
—
TN
05
—
3379860
—
TN
01
—
4204226
BCBST
TN
Enumeration date
08/03/2006
Last updated
01/07/2022
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