Provider Demographics
NPI:1891708012
Name:GENTRY, SHAWN N (MD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:N
Last Name:GENTRY
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 1:1605 NASHVILLE HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-2071
Mailing Address - Country:US
Mailing Address - Phone:931-540-4210
Mailing Address - Fax:931-380-1202
Practice Address - Street 1:1605 NASHVILLE HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-2071
Practice Address - Country:US
Practice Address - Phone:931-540-4210
Practice Address - Fax:931-380-1202
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29588207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3107310OtherBCBSTN
TN3710087Medicaid
TN3820281Medicaid
TN3710089Medicaid
TN3710087Medicare PIN
TN3710087Medicaid
TN080135042Medicare PIN
TN3710089Medicare PIN
TNG63472Medicare UPIN
TN103I088270Medicare PIN
TN3107310OtherBCBSTN