Healthcare Provider Details

I. General information

NPI: 1194458612
Provider Name (Legal Business Name): JONAH SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 KIMBROUGH RD
GERMANTOWN TN
38138-2405
US

IV. Provider business mailing address

1432 KIMBROUGH RD
GERMANTOWN TN
38138-2405
US

V. Phone/Fax

Practice location:
  • Phone: 901-767-4499
  • Fax:
Mailing address:
  • Phone: 901-767-4499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number36936
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberE-20550
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number76947
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: