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General NPI Number Information
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NPI Number | 1508979097
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Entity Type | Individual
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Provider Name | FATISHA GAYTON MD
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Gender | Female
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 9501 FARRELL RD
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City | FORT BELVOIR
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State | VA
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Zip | 22060-5901
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Country | US
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Telephone | 703-805-0510
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Fax |
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Provider Business Mailing Address
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Address Line | 1850 POTOMAC GREENS DR
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City | ALEXANDRIA
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State | VA
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Zip | 22314-6237
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Country | US
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Telephone | 404-840-6575
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 010124449
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 054612
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | D68201
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License Number State | MD
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