Provider Demographics
NPI:1972680718
Name:JIMMY B SHEATS D.D.S., P.C.
Entity Type:Organization
Organization Name:JIMMY B SHEATS D.D.S., P.C.
Other - Org Name:SHEATS ENDODONTIC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHEATS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-320-0099
Mailing Address - Street 1:1915 CHARLOTTE AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2130
Mailing Address - Country:US
Mailing Address - Phone:615-320-0099
Mailing Address - Fax:615-825-0006
Practice Address - Street 1:1915 CHARLOTTE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2130
Practice Address - Country:US
Practice Address - Phone:615-320-0099
Practice Address - Fax:615-825-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29571223E0200X
TN77161223E0200X
TN78071223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0005116Medicaid
TN5440915Medicaid
TN5440917Medicaid