Healthcare Provider Details

I. General information

NPI: 1730743832
Provider Name (Legal Business Name): PRASHANT MISHRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MADISON AVE STE 447
MEMPHIS TN
38103-3438
US

IV. Provider business mailing address

956 COURT AVE STE H314
MEMPHIS TN
38103-2814
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-5814
  • Fax:
Mailing address:
  • Phone: 901-448-5704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number64788
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number12912330
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: