Healthcare Provider Details

I. General information

NPI: 1750764114
Provider Name (Legal Business Name): ALISHA GUPTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6029 WALNUT GROVE RD STE 210
MEMPHIS TN
38120-2112
US

IV. Provider business mailing address

965 RIDGE LAKE BLVD STE 103
MEMPHIS TN
38120-9446
US

V. Phone/Fax

Practice location:
  • Phone: 901-226-4770
  • Fax: 901-226-4915
Mailing address:
  • Phone:
  • Fax: 901-227-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number62476
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: