Healthcare Provider Details

I. General information

NPI: 1104804228
Provider Name (Legal Business Name): JOHN LEE SHUSTER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 DUKE DR SUITE 210
FRANKLIN TN
37067-2706
US

IV. Provider business mailing address

714 SINCLAIR CIRCLE
BRENTWOOD TN
37027
US

V. Phone/Fax

Practice location:
  • Phone: 844-291-4535
  • Fax:
Mailing address:
  • Phone: 615-720-8971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberMD0000045996
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number15804
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD0000045996
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code2084H0002X
TaxonomyHospice and Palliative Medicine (Psychiatry & Neurology) Physician
License NumberMD0000045996
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: