Provider Demographics
NPI:1205836566
Name:FORD, TASHA J (MD)
Entity Type:Individual
Prefix:DR
First Name:TASHA
Middle Name:J
Last Name:FORD
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:842 JEFFERSON AVE
Mailing Address - Street 2:SUITE A645
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2808
Mailing Address - Country:US
Mailing Address - Phone:901-545-8699
Mailing Address - Fax:901-545-8998
Practice Address - Street 1:877 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2807
Practice Address - Country:US
Practice Address - Phone:901-545-8699
Practice Address - Fax:901-545-8998
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2016-05-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN31431207PP0204X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3633676Medicaid
TNH02756Medicare UPIN