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General NPI Number Information
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NPI Number | 1821529546
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Entity Type | Individual
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Provider Name | SHIVANI BHATNAGAR M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/23/2017
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 294 SUMMAR DR
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City | JACKSON
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State | TN
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Zip | 38301-3915
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Country | US
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Telephone | 731-541-4755
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Fax |
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Provider Business Mailing Address
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Address Line | 11002 AVERY ARBOR LN
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City | CYPRESS
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State | TX
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Zip | 77433-5333
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Country | US
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Telephone | 404-667-4721
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 61390
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME158702
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License Number State | FL
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