Provider Demographics
NPI:1346421153
Name:JOHN A. SHULL, M.D., P.C.
Entity Type:Organization
Organization Name:JOHN A. SHULL, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:SHULL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-855-0357
Mailing Address - Street 1:929 SPRING CREEK RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-3964
Mailing Address - Country:US
Mailing Address - Phone:423-855-0357
Mailing Address - Fax:423-855-4917
Practice Address - Street 1:929 SPRING CREEK RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-3964
Practice Address - Country:US
Practice Address - Phone:423-855-0357
Practice Address - Fax:423-855-4917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10078174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0024916OtherBCBS
TN0024916OtherBCBS