Provider Demographics
NPI:1205828837
Name:SHAFFER, JORI LYNNE (MD)
Entity Type:Individual
Prefix:MRS
First Name:JORI
Middle Name:LYNNE
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 HIGHWAY 111
Mailing Address - Street 2:
Mailing Address - City:BYRDSTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38549-6031
Mailing Address - Country:US
Mailing Address - Phone:931-864-3187
Mailing Address - Fax:931-864-7102
Practice Address - Street 1:8401 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:BYRDSTOWN
Practice Address - State:TN
Practice Address - Zip Code:38549
Practice Address - Country:US
Practice Address - Phone:931-864-3187
Practice Address - Fax:931-864-7102
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34603208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3873889Medicaid
H60370Medicare UPIN
TN3873889Medicaid