Provider Demographics
NPI:1801917208
Name:SHELTON, MICHAEL LYNN
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LYNN
Last Name:SHELTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1223
Mailing Address - Street 2:
Mailing Address - City:CHURCH HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37642
Mailing Address - Country:US
Mailing Address - Phone:423-384-5150
Mailing Address - Fax:423-357-5786
Practice Address - Street 1:622 LAZY LN
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:TN
Practice Address - Zip Code:37645
Practice Address - Country:US
Practice Address - Phone:423-384-5150
Practice Address - Fax:423-357-5786
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0105343343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)