Healthcare Provider Details

I. General information

NPI: 1861308629
Provider Name (Legal Business Name): CHRISTOPHER JAMES SHAY IV PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ADDRESS: 6965 CUMBERLAND GAP PKWY
HARROGATE TN
37752-8245
US

IV. Provider business mailing address

6965 CUMBERLAND GAP PKWY
HARROGATE TN
37752-8245
US

V. Phone/Fax

Practice location:
  • Phone: 423-869-7200
  • Fax: 423-869-7172
Mailing address:
  • Phone: 423-869-7200
  • Fax: 423-869-7172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: