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
—
—
Other
Enumeration date
05/29/2023
Last updated
11/01/2024
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