Provider Demographics
NPI:1669458345
Name:GETOLA, SHAWN R (HS / AMS)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:R
Last Name:GETOLA
Suffix:
Gender:M
Credentials:HS / AMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 AUCTION AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-1502
Mailing Address - Country:US
Mailing Address - Phone:901-544-3912
Mailing Address - Fax:901-544-3915
Practice Address - Street 1:2 AUCTION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-1502
Practice Address - Country:US
Practice Address - Phone:901-544-3912
Practice Address - Fax:901-544-3915
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Not Answered1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians