Healthcare Provider Details

I. General information

NPI: 1154883452
Provider Name (Legal Business Name): JOHN PHILIP SHILLINGLAW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY # U-11
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

1924 ALCOA HWY # U-11
KNOXVILLE TN
37920-1511
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9006
  • Fax: 865-305-6958
Mailing address:
  • Phone: 865-305-9006
  • Fax: 865-305-6958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number70715
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number89834
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number70715
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: