Provider Demographics
NPI:1508979097
Name:GAYTON, FATISHA (MD)
Entity Type:Individual
Prefix:DR
First Name:FATISHA
Middle Name:
Last Name:GAYTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FATISHA
Other - Middle Name:TAWANHA
Other - Last Name:ENAHORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1850 POTOMAC GREENS DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-6237
Mailing Address - Country:US
Mailing Address - Phone:404-840-6575
Mailing Address - Fax:
Practice Address - Street 1:9501 FARRELL RD
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5901
Practice Address - Country:US
Practice Address - Phone:703-805-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010124449207P00000X
GA054612207P00000X
MDD68201207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI12930Medicare UPIN