Individual
DR. KHAISHA VERDELLE GIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5380 HICKORY HOLLOW PKWY STE 205, ANTIOCH, TN 37013-3389
(615) 412-8662
(615) 270-2493
Mailing address
2723 NEW SALEM HWY, MURFREESBORO, TN 37128-5253
(615) 410-9360
(833) 944-2291
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
57747
TN
207Q00000X
Family Medicine Physician
Primary
MD0000057747
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1184011835
RESIDENT/TRAINING PROGRAM
TN
01
—
MD0000057747
TN LICENSE
TN
Enumeration date
04/21/2015
Last updated
07/23/2023
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