Provider Demographics
NPI:1053727602
Name:GETTIS, ERICA LAFAYE (D O)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:LAFAYE
Last Name:GETTIS
Suffix:
Gender:F
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-210-4530
Mailing Address - Fax:502-210-4531
Practice Address - Street 1:2401 TERRA CROSSING BLVD STE 402
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-5371
Practice Address - Country:US
Practice Address - Phone:502-210-4530
Practice Address - Fax:502-210-4531
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116027328207R00000X
KY04121207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100504290Medicaid