Provider Demographics
NPI:1467496976
Name:JAHAN, MOHAMMAD SHAH (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:SHAH
Last Name:JAHAN
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 1:815 WREN RD
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2316
Mailing Address - Country:US
Mailing Address - Phone:615-851-3063
Mailing Address - Fax:615-851-3048
Practice Address - Street 1:815 WREN RD
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2316
Practice Address - Country:US
Practice Address - Phone:615-851-3063
Practice Address - Fax:615-851-3048
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000193252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3065811Medicaid
TN3065811Medicaid
TN3065811Medicare ID - Type UnspecifiedMEDICARE NUMBER