Provider Demographics
NPI:1154075752
Name:SHAFFER, LILLIAN SHADE (MMS, PA-C)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:SHADE
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:SHADE
Other - Last Name:EPES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6145 SHALLOWFORD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7808
Mailing Address - Country:US
Mailing Address - Phone:423-893-6890
Mailing Address - Fax:423-648-1115
Practice Address - Street 1:6145 SHALLOWFORD RD STE 102
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7808
Practice Address - Country:US
Practice Address - Phone:423-893-6890
Practice Address - Fax:423-648-1115
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical