Healthcare Provider Details

I. General information

NPI: 1831253640
Provider Name (Legal Business Name): SHIMON OAMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4548 BRAINERD RD
CHATTANOOGA TN
37411-5442
US

IV. Provider business mailing address

4548 BRAINERD RD STE 102
CHATTANOOGA TN
37411-5440
US

V. Phone/Fax

Practice location:
  • Phone: 423-521-1100
  • Fax: 423-531-7502
Mailing address:
  • Phone: 423-521-1100
  • Fax: 423-531-7502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberME0084307
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number046797
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number25MA07712800
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberME0084307
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number25MA07712800
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number192231
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number046797
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME0084307
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number192231
License Number StateNY
# 10
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number25MA07712800
License Number StateNJ
# 11
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number192231
License Number StateNY
# 12
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number046797
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: