Provider Demographics
NPI:1710373279
Name:TASHIMA, ALEXIS D (MD)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:D
Last Name:TASHIMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:T
Other - Last Name:ROTHERMEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 CHILDRENS WAY # 653
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-1100
Mailing Address - Fax:501-364-4082
Practice Address - Street 1:5461 MERIDIAN MARK RD STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4014
Practice Address - Country:US
Practice Address - Phone:404-785-5437
Practice Address - Fax:404-785-3706
Is Sole Proprietor?:No
Enumeration Date:2015-04-11
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA896382086S0120X
ARE-157422086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery