Provider Demographics
NPI:1962183970
Name:ALBITAWI, AHMAD
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:ALBITAWI
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 1:11300 LATTING RD
Mailing Address - Street 2:
Mailing Address - City:EADS
Mailing Address - State:TN
Mailing Address - Zip Code:38028-7013
Mailing Address - Country:US
Mailing Address - Phone:901-319-2819
Mailing Address - Fax:
Practice Address - Street 1:11300 LATTING RD
Practice Address - Street 2:
Practice Address - City:EADS
Practice Address - State:TN
Practice Address - Zip Code:38028-7013
Practice Address - Country:US
Practice Address - Phone:901-319-2819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver