1639125560 NPI number — FAWWAZ A ALKAYYALI MD

Table of content: FAWWAZ A ALKAYYALI MD (NPI 1639125560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639125560 NPI number — FAWWAZ A ALKAYYALI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALKAYYALI
Provider First Name:
FAWWAZ
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639125560
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 110925
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37222-0925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-781-1935
Provider Business Mailing Address Fax Number:
615-781-1936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
393 WALLACE RD STE A302
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37211-4983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-781-1935
Provider Business Practice Location Address Fax Number:
615-781-1936
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  27572 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4024735 . This is a "BCBST" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 009975320 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3731879 . This is a "MEDICARE PIN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 009941739 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3097985 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3097984 . This is a "MEDICAID PIN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 890-12152 . This is a "BCBSAL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 4024735 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: P00403756 . This is a "RAILROAD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4024735 . This is a "BCBSTN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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