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Organization
HYDE PARK MEDICAL GROUP, PLLC
Active
Organization
HYDE PARK MEDICAL GROUP, PLLC
Active
Other names
Hyde Park Medical
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KHAISHA GIST MD (MEDICAL DIRECTOR)
(773) 802-2723
Entity
Organization
Contact information
Practice address
741 PRESIDENT PL STE 140, SMYRNA, TN 37167-6808
(615) 412-8662
Mailing address
PO BOX 23, GLADEVILLE, TN 37071-0023
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
05/29/2023
Last updated
11/01/2024
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