Provider Demographics
NPI:1235107368
Name:AL-TAHER, MOHAMMED TAHER I (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:TAHER
Last Name:AL-TAHER
Suffix:I
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 1:1176 VICKERY LN STE 100
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-0631
Mailing Address - Country:US
Mailing Address - Phone:901-737-1992
Mailing Address - Fax:901-309-8784
Practice Address - Street 1:3173 KIRBY WHITTEN RD STE 104
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2881
Practice Address - Country:US
Practice Address - Phone:901-380-8040
Practice Address - Fax:901-309-8784
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN411832084P0800X
ARE30442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
11591588OtherCAQH
AR134589726Medicaid