Healthcare Provider Details

I. General information

NPI: 1821529546
Provider Name (Legal Business Name): SHIVANI BHATNAGAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 SUMMAR DR
JACKSON TN
38301-3915
US

IV. Provider business mailing address

11002 AVERY ARBOR LN
CYPRESS TX
77433-5333
US

V. Phone/Fax

Practice location:
  • Phone: 731-541-4755
  • Fax:
Mailing address:
  • Phone: 404-667-4721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME158702
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number61390
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: