Healthcare Provider Details

I. General information

NPI: 1669421814
Provider Name (Legal Business Name): SHAUN C CORBIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 N JAMES CAMPBELL BLVD STE 101
COLUMBIA TN
38401-6436
US

IV. Provider business mailing address

927 N JAMES CAMPBELL BLVD STE 101
COLUMBIA TN
38401-6436
US

V. Phone/Fax

Practice location:
  • Phone: 931-380-9166
  • Fax: 931-388-4105
Mailing address:
  • Phone: 931-380-9166
  • Fax: 931-388-4105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number30290
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number30290
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number30290
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: