Provider Demographics
NPI:1245236009
Name:HANCOCK, SHANNON PAUL (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:PAUL
Last Name:HANCOCK
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 1:4138 DURHAM LNDG
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-1006
Mailing Address - Country:US
Mailing Address - Phone:423-586-1717
Mailing Address - Fax:423-586-1763
Practice Address - Street 1:4138 DURHAM LNDG
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-1006
Practice Address - Country:US
Practice Address - Phone:423-586-1717
Practice Address - Fax:423-586-1763
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3325017Medicaid
TN3325017Medicaid
TNI20279Medicare UPIN