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General NPI Number Information
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NPI Number | 1922022672
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Entity Type | Individual
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Provider Name | SIBAJI SHOME M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 07/24/2007
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Provider Practice Location Address
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Address Line | 979 E 3RD ST STE A-240 A-240
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City | CHATTANOOGA
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State | TN
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Zip | 37403-2136
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Country | US
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Telephone | 423-778-5199
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Fax | 423-778-2112
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Provider Business Mailing Address
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Address Line | 206 MATHES LN
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City | SIGNAL MOUNTAIN
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State | TN
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Zip | 37377-2266
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Country | US
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Telephone | 423-629-5098
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Fax | 423-629-6078
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 0000024694
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 0024694
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License Number State | TN
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