Healthcare Provider Details

I. General information

NPI: 1205769155
Provider Name (Legal Business Name): JEFFERSON COSMETIC SURGERY CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 PRESIDENT PL STE 120
SMYRNA TN
37167-6845
US

IV. Provider business mailing address

5064 REPUBLIC AVE
MURFREESBORO TN
37129-7674
US

V. Phone/Fax

Practice location:
  • Phone: 615-768-5003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALISHA JEFFERSON
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 615-598-2600