Provider Demographics
NPI:1649594219
Name:CONWAY, ALISHA K (MD)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:K
Last Name:CONWAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:DEMIL
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2555 DIBRELL TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-8980
Mailing Address - Country:US
Mailing Address - Phone:501-733-1712
Mailing Address - Fax:
Practice Address - Street 1:5150 AIRLINE RD STE 300
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-9200
Practice Address - Country:US
Practice Address - Phone:901-752-6963
Practice Address - Fax:901-260-9354
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR7971207Q00000X
TN48360207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine