Provider Demographics
NPI:1710951942
Name:SHOPTAW JR., JAMES H (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:SHOPTAW JR.
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 1:4731 WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6220
Mailing Address - Country:US
Mailing Address - Phone:606-439-0447
Mailing Address - Fax:606-436-0408
Practice Address - Street 1:243 ROY CAMPBELL DR
Practice Address - Street 2:SUITE A
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701
Practice Address - Country:US
Practice Address - Phone:606-439-0447
Practice Address - Fax:606-436-0408
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033699208G00000X
KY37469208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61-1427889OtherTRICARE
KY61-1427889OtherCHA
KY61-1427889OtherUHC
KYC91818OtherCUMBERLAND HEALTHCARE INC
KY61-1427889OtherBLUEGRASS FAMILY HEALTH
KY000000377924OtherANTHEM PROVIDER #
KY50005330OtherPASSPORT HEALTH PLAN
KY64054315Medicaid
KYP00276210OtherRRMCR
KY030670000OtherBLACK LUNG
KY61-1427889OtherHUMANA
KY030670000OtherBLACK LUNG
KYP00276210OtherRRMCR