Healthcare Provider Details

I. General information

NPI: 1629536263
Provider Name (Legal Business Name): ADIL SHABAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 CASTLEWOOD DR STE F
MURFREESBORO TN
37129-5168
US

IV. Provider business mailing address

229 CASTLEWOOD DR STE F
MURFREESBORO TN
37129-5168
US

V. Phone/Fax

Practice location:
  • Phone: 615-767-1042
  • Fax:
Mailing address:
  • Phone: 615-767-1042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number288331
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000221959
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0000221959
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: