Fausta Ditah

NPI 1063675692 - Internal Medicine - 207RG0100X

NPI Details
NPI 1063675692
Gender Male
Enumeration Date 07/03/2008
Last Updated 06/18/2014
Entity Type Individual
Active Over 8 years ago
Practice Location
700 W FOREST AVE
STE 300
JACKSON TN, 38301-3937, US
Phone (731) 422-0305
Fax (731) 422-0357
Business Location
PO BOX 400
JACKSON TN, 38302-0400, US
Phone (731) 423-8697
Fax (731) 425-5783
Toxanomy
Taxonomy Code 207RG0100X
License State Tennessee
License Number MD50497
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According to our database, Dr. Fausta Ditah NPI is 1063675692, taxonomy code is 207RG0100X and license number is MD50497, license state is located at Tennessee. Fausta Ditah physically located at 700 W Forest Ave, Jackson TN, 38301-3937. NPI Number Fausta Ditah has the Individual type.

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1063675692 NPI number is provided on an as is basis without warranty of any kind. 1063675692 is maintained by the National Plan & Provider Enumeration System. The contents of Fausta Ditah are for informational purposes only.