Provider Demographics
NPI:1598860157
Name:MISHRA, GITA (MD)
Entity Type:Individual
Prefix:DR
First Name:GITA
Middle Name:
Last Name:MISHRA
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 1:4532 S CAROTHERS RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-4089
Mailing Address - Country:US
Mailing Address - Phone:615-591-4365
Mailing Address - Fax:
Practice Address - Street 1:205 DONELSON PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-2903
Practice Address - Country:US
Practice Address - Phone:615-885-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD8780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3166992Medicaid
TN3166992Medicare ID - Type UnspecifiedMEDICARE
TN3166992Medicaid