Provider Demographics
NPI:1912957937
Name:SHIPLEY, JAMES M (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:SHIPLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1497 W ELK AVE
Mailing Address - Street 2:SUITE 21
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2895
Mailing Address - Country:US
Mailing Address - Phone:423-542-7420
Mailing Address - Fax:423-542-7425
Practice Address - Street 1:1497 W ELK AVE
Practice Address - Street 2:SUITE 21
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2895
Practice Address - Country:US
Practice Address - Phone:423-542-7420
Practice Address - Fax:423-542-7425
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2017-02-09
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Provider Licenses
StateLicense IDTaxonomies
TN35197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ003315Medicaid
VA1912957937Medicaid
TN3865578Medicare PIN
VA1912957937Medicaid