Provider Demographics
NPI:1710187406
Name:TOOMBS-WITHERS, SHAYLA MONIQUE (DO)
Entity Type:Individual
Prefix:DR
First Name:SHAYLA
Middle Name:MONIQUE
Last Name:TOOMBS-WITHERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:SHAYLA
Other - Middle Name:MONIQUE
Other - Last Name:TOOMBS-WITHERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:752 E. MLK BLVD.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403
Mailing Address - Country:US
Mailing Address - Phone:423-805-2245
Mailing Address - Fax:423-845-9602
Practice Address - Street 1:752 E. MLK BLVD.
Practice Address - Street 2:SUITE 102
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403
Practice Address - Country:US
Practice Address - Phone:423-805-2245
Practice Address - Fax:423-845-9602
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4413207Q00000X
TN2866207QB0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1114906906Medicaid