Jermaine Ash-Shaheed Ali, MD

Individual provider Active NPI Child & Adolescent Psychiatry Physician · Louisville, KY

NPI 1659544948 · NPPES record last updated Nov 11, 2013

Key facts

NPI
1659544948
Entity type
Individual (NPI type 1)
Primary specialty
Child & Adolescent Psychiatry Physician 2084P0804X
License
44386 (KY)
Practice address
2225 W Broadway
Louisville, KY 40211-1003
Phone
(502) 589-8910
Fax
(502) 772-2084
NPI assigned
Apr 8, 2008
Sex
Male
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Seven Counties Services, Inc. Past
since May 13, 2019
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X 44386 KY Yes

Addresses

Primary practice location

2225 W Broadway
Louisville, KY 40211-1003

Mailing address

2225 W Broadway
Louisville, KY 40211-1003
Phone (502) 589-8910

Other providers in Louisville, KY

All providers in Louisville, KY · Child & Adolescent Psychiatry Physician in Kentucky

Sources for this page

Verify at the official NPI Registry.