MEDICARE: HARTLINE & SHAHBAZI GYNECOLOGY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1306962683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARTLINE & SHAHBAZI GYNECOLOGY, PLLC

Provider Business Mailing Address
First Line	:	930 E EMERALD AVE
Second Line	:	STE 713
City	:	KNOXVILLE
State	:	TN
Zip	:	37917-4539
Country	:	US
Telephone Number	:	865-544-1345
Fax Number	:	865-544-1344

Provider Business Practice Location Address
First Line	:	930 E EMERALD AVE
Second Line	:	STE 713
City	:	KNOXVILLE
State	:	TN
Zip	:	37917-4539
Country	:	US
Telephone Number	:	865-544-1345
Fax Number	:	865-544-1344

Authorized Official
Title or Position	:	OWNER
Name	:	RANDAL GARNETT HARTLINE
Credential	:	MD
Telephone Number	:	865-544-1345

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	08/22/2020

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