Provider Demographics
NPI:1124122114
Name:GARATLI, ALI AL (MD)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:AL
Last Name:GARATLI
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 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:109 WEST WATAUGA AVENUE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37605
Practice Address - Country:US
Practice Address - Phone:423-232-2600
Practice Address - Fax:423-232-2646
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012384402084P0800X
TN337852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
278258WATOtherANTHEM PREF TRIGON
5629853OtherFIRST HEALTH
187078 RIDGEVIEWOtherANTHEM PROF TRIGON
187078 RIDGEVIEWOtherANTHEM PREF TRIGON
278259BAXOtherANTHEM PREF TRIGON
278261 CTCOtherANTHEM PROF TRIGON
278261 CTCOtherANTHEM PREF TRIGON
4002680OtherMAGELLAN SUMMIT
278259BAXOtherANTHEM PROF TRIGON
278258WATOtherANTHEM PROF TRIGON
4002680OtherMAGELLAN PINNACLE
4002680OtherMAGELLAN NAVIGATOR
TN3729687Medicare ID - Type UnspecifiedGRP
187078 RIDGEVIEWOtherANTHEM PREF TRIGON
278261 CTCOtherANTHEM PROF TRIGON
278259BAXOtherANTHEM PREF TRIGON
4002680OtherMAGELLAN PINNACLE