Healthcare Provider Details

I. General information

NPI: 1629816913
Provider Name (Legal Business Name): SHAKTI'S GREENHOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8336 MACON ROAD
CORDOVA TN
38018
US

IV. Provider business mailing address

8336 MACON RD
CORDOVA TN
38018-8554
US

V. Phone/Fax

Practice location:
  • Phone: 901-277-8713
  • Fax: 901-682-3049
Mailing address:
  • Phone: 901-628-3035
  • Fax: 901-682-3049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SHUBI ADYA SHAKTI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 901-277-8713