Healthcare Provider Details

I. General information

NPI: 1033282033
Provider Name (Legal Business Name): JOHNNA JC SHOCKLEY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 E EMORY RD
KNOXVILLE TN
37938-4431
US

IV. Provider business mailing address

1340 E EMORY RD
KNOXVILLE TN
37938-4431
US

V. Phone/Fax

Practice location:
  • Phone: 865-947-9890
  • Fax: 865-947-9895
Mailing address:
  • Phone: 865-947-9890
  • Fax: 865-947-9895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS7690
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: