Healthcare Provider Details

I. General information

NPI: 1972700896
Provider Name (Legal Business Name): ANNE GROTHEER SHULL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9527 W RIDGE TRAIL RD
SODDY DAISY TN
37379-4018
US

IV. Provider business mailing address

510 WINSTON RD
CHATTANOOGA TN
37405-4238
US

V. Phone/Fax

Practice location:
  • Phone: 423-842-3031
  • Fax:
Mailing address:
  • Phone: 423-634-0292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number42360,
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: