Provider Demographics
NPI:1538104526
Name:HENDERSON-FITTS, ALLIE K (MD)
Entity Type:Individual
Prefix:
First Name:ALLIE
Middle Name:K
Last Name:HENDERSON-FITTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1852
Mailing Address - Country:US
Mailing Address - Phone:629-255-3486
Mailing Address - Fax:
Practice Address - Street 1:5653 FRIST BLVD
Practice Address - Street 2:SUITE 630
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076
Practice Address - Country:US
Practice Address - Phone:629-255-2105
Practice Address - Fax:629-255-4147
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD44801207R00000X
TN44801208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1513832Medicaid
TNI55001Medicare UPIN
TN1513832Medicaid
TN103I117089Medicare PIN
TN3041564Medicare PIN
TN9254334OtherAETNA