# HYDE PARK MEDICAL GROUP, PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Hyde Park Medical
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043903990
- **Authorized official:** DR. KHAISHA GIST MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (773) 802-2723

## Contact information

- **Practice address:** 741 PRESIDENT PL STE 140, SMYRNA, TN 37167-6808
- **Practice address phone:** (615) 412-8662
- **Mailing address:** PO BOX 23, GLADEVILLE, TN 37071-0023

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/29/2023
- **Last updated:** 11/01/2024