Provider Demographics
NPI:1588711469
Name:THROCKMORTON, ALYSSA D (MD)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:D
Last Name:THROCKMORTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 405827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5827
Mailing Address - Country:US
Mailing Address - Phone:901-227-4068
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:7205 WOLF RIVER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1777
Practice Address - Country:US
Practice Address - Phone:901-227-8950
Practice Address - Fax:901-227-8951
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA103820208600000X
TN444062086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I910615Medicare PIN