Healthcare Provider Details

I. General information

NPI: 1285570267
Provider Name (Legal Business Name): FLORA MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1108 LOGUE RD
MOUNT JULIET TN
37122-3837
US

IV. Provider business mailing address

PO BOX 23
GLADEVILLE TN
37071-0023
US

V. Phone/Fax

Practice location:
  • Phone: 615-412-8657
  • Fax: 615-270-2493
Mailing address:
  • Phone: 615-412-8657
  • Fax: 615-270-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KHAISHA GIST
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 615-412-8572