Provider Demographics
NPI:1942212691
Name:SHULL, JOHN ALBERT (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ALBERT
Last Name:SHULL
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 1:929 SPRING CREEK RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-3964
Mailing Address - Country:US
Mailing Address - Phone:423-855-0357
Mailing Address - Fax:423-855-4917
Practice Address - Street 1:929 SPRING CREEK RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-3964
Practice Address - Country:US
Practice Address - Phone:423-855-0357
Practice Address - Fax:423-855-4917
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10078207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0024916OtherBCBST
TNBO3874Medicare UPIN
TN3179725Medicare ID - Type Unspecified