Healthcare Provider Details

I. General information

NPI: 1487573119
Provider Name (Legal Business Name): ARIELLE SHAW PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 SAGE RD N STE 1100
WHITE HOUSE TN
37188-9363
US

IV. Provider business mailing address

3144 OLD FRANKLIN RD APT 5108
ANTIOCH TN
37013-4787
US

V. Phone/Fax

Practice location:
  • Phone: 615-672-5575
  • Fax:
Mailing address:
  • Phone: 404-453-0260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: