Provider Demographics
NPI:1700461522
Name:SHOTS PLUS MORE
Entity Type:Organization
Organization Name:SHOTS PLUS MORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-623-4138
Mailing Address - Street 1:6634 OLIVIA FOREST RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-0450
Mailing Address - Country:US
Mailing Address - Phone:901-623-4138
Mailing Address - Fax:
Practice Address - Street 1:6634 OLIVIA FOREST RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-0450
Practice Address - Country:US
Practice Address - Phone:901-623-4138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare