Basic Information
| Provider Information | |||||||||
| NPI: | 1750608113 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FANTA | ||||||||
| FirstName: | SAVITA | ||||||||
| MiddleName: | LEANNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2340 FAIRVIEW BLVD STE 600D | ||||||||
| Address2: | |||||||||
| City: | FAIRVIEW | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370629457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152662177 | ||||||||
| FaxNumber: | 6152662331 | ||||||||
| Practice Location | |||||||||
| Address1: | 2340 FAIRVIEW BLVD STE 600D | ||||||||
| Address2: | |||||||||
| City: | FAIRVIEW | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152662177 | ||||||||
| FaxNumber: | 9316705312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2010 | ||||||||
| LastUpdateDate: | 12/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 48530 | TN | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 48530 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | Q008516 | 05 | TN | MEDICAID |