Provider Demographics
NPI:1386305993
Name:ISMAIL, QANI
Entity type:Individual
Prefix:
First Name:QANI
Middle Name:
Last Name:ISMAIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 MURFREESBORO PIKE STE 105
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-1538
Mailing Address - Country:US
Mailing Address - Phone:615-900-5599
Mailing Address - Fax:
Practice Address - Street 1:1040 MURFREESBORO PIKE STE 105
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-1538
Practice Address - Country:US
Practice Address - Phone:615-900-5599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN222925