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General NPI Number Information
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NPI Number | 1255748059
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Entity Type | Organization
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Legal Business Name | SHULTS PEDIATRICS, P. C.
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Dates
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Enumeration Date | 07/14/2014
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Last Update Date | 07/14/2014
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Provider Practice Location Address
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Address Line | 9142 S NORTHSHORE DR
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City | KNOXVILLE
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State | TN
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Zip | 37922-6325
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Country | US
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Telephone | 865-670-1560
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Fax | 865-670-1560
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Provider Business Mailing Address
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Address Line | 9142 S NORTHSHORE DR
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City | KNOXVILLE
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State | TN
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Zip | 37922-6325
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Country | US
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Telephone | 865-670-1560
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Fax | 865-670-1560
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | RANDALL SHULTS
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Credential |
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Telephone | 865-670-1560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD0000024906
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License Number State | TN
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