Provider Demographics
NPI:1942245683
Name:SHACKELFORD, CLAUDE EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:CLAUDE
Middle Name:EDWARD
Last Name:SHACKELFORD
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 1:3841 GREEN HILLS VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:615-936-2000
Mailing Address - Fax:
Practice Address - Street 1:3098 CAMPBELL STATION PKWY
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-6270
Practice Address - Country:US
Practice Address - Phone:615-302-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37507207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3885778Medicaid
TN3885771OtherMISSISSIPPI BLUE CROSS
TN3718641Medicaid
TN4062023OtherBCBST
TN3710089Medicaid
TN3885771Medicaid
TN4088605OtherBLUE CROSS
TN3885773Medicare PIN
TN3885771OtherMISSISSIPPI BLUE CROSS
TN3710089Medicaid
TN3885772Medicare PIN
TNP00034706Medicare PIN
TNCE0561Medicare PIN
TN3885778Medicare PIN
TN3718641Medicaid