Healthcare Provider Details

I. General information

NPI: 1194155903
Provider Name (Legal Business Name): SHAUNA GREGORY MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 4000
MOUNTAIN HOME TN
37684-4000
US

IV. Provider business mailing address

PO BOX 4000
MOUNTAIN HOME TN
37684-4000
US

V. Phone/Fax

Practice location:
  • Phone: 423-926-1171
  • Fax: 423-979-3061
Mailing address:
  • Phone: 423-926-1171
  • Fax: 423-979-3061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: