Healthcare Provider Details

I. General information

NPI: 1528687647
Provider Name (Legal Business Name): ALISHA FUJITA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 MARYLAND WAY STE 300
BRENTWOOD TN
37027-7516
US

IV. Provider business mailing address

5121 MARYLAND WAY STE 300
BRENTWOOD TN
37027-7516
US

V. Phone/Fax

Practice location:
  • Phone: 855-246-8607
  • Fax:
Mailing address:
  • Phone: 855-246-8607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number010148
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: