Healthcare Provider Details

I. General information

NPI: 1124551692
Provider Name (Legal Business Name): SCOTT NELSON SHEPPARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8147 PINE CRK W
GERMANTOWN TN
38138-4120
US

IV. Provider business mailing address

8147 PINE CRK W
GERMANTOWN TN
38138-4120
US

V. Phone/Fax

Practice location:
  • Phone: 919-604-3574
  • Fax:
Mailing address:
  • Phone: 919-604-3574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number75216
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: