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General NPI Number Information
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NPI Number | 1194757096
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Entity Type | Individual
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Provider Name | SHANTHA GRACE PANDIAN MD
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Gender | Female
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | JAMES H.QUILLEN/VAMC CORNER OF SYDNEY AND LAMONT
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City | MOUNTAIN HOME
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State | TN
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Zip | 37684
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Country | US
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Telephone | 423-926-1171
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Fax | 423-979-3431
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Provider Business Mailing Address
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Address Line | 3 HUNTERS RIDGE RD
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City | JOHNSON CITY
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State | TN
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Zip | 37604-8329
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Country | US
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Telephone | 423-929-1754
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD0000034812
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME 88967
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License Number State | FL
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