Healthcare Provider Details

I. General information

NPI: 1699154625
Provider Name (Legal Business Name): ALISHA SMITH PARKER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISHA SMITH

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 12TH ST
MERIDIAN MS
39301-4158
US

IV. Provider business mailing address

PO BOX 5392
MERIDIAN MS
39302-5392
US

V. Phone/Fax

Practice location:
  • Phone: 601-484-6700
  • Fax: 601-703-3024
Mailing address:
  • Phone: 601-484-6700
  • Fax: 601-703-3024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberAU5009697-2673
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number24941
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: