Provider Demographics
NPI:1528555711
Name:SHACKSON, JOEL CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:CHRISTOPHER
Last Name:SHACKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 ARCH ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1436
Mailing Address - Country:US
Mailing Address - Phone:330-375-3315
Mailing Address - Fax:330-375-7779
Practice Address - Street 1:1718 PATTERSON ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2926
Practice Address - Country:US
Practice Address - Phone:615-327-1085
Practice Address - Fax:615-346-8547
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN66385207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine