Healthcare Provider Details

I. General information

NPI: 1831385012
Provider Name (Legal Business Name): JAYRAJ C. SHAH, MD,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 N LOCUST AVE
LAWRENCEBURG TN
38464-3518
US

IV. Provider business mailing address

PO BOX 508
LAWRENCEBURG TN
38464-0508
US

V. Phone/Fax

Practice location:
  • Phone: 931-762-8588
  • Fax: 931-766-1010
Mailing address:
  • Phone: 931-762-8588
  • Fax: 931-766-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number12977
License Number StateTN

VIII. Authorized Official

Name: JAYRAJ C. SHAH
Title or Position: OWNER/MD
Credential: MD
Phone: 931-762-8588