Provider Demographics
NPI:1013013101
Name:SHULTS, JONATHAN MICHAEL (MD)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:MICHAEL
Last Name:SHULTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6715 FOREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2507
Mailing Address - Country:US
Mailing Address - Phone:912-777-6920
Mailing Address - Fax:912-777-4018
Practice Address - Street 1:6715 FOREST PARK DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2507
Practice Address - Country:US
Practice Address - Phone:912-777-6920
Practice Address - Fax:912-777-4018
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024049207X00000X
GA75377207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1422649Medicaid
LAH64715Medicare UPIN
LA4J8627627Medicare PIN
LA1422649Medicaid
LA4J862Medicare PIN