MEDICARE: DR. SHANNON O MCCALLIE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35192	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740275031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON O MCCALLIE MD

Provider Business Mailing Address
First Line	:	4976 ALPHA LN
Second Line	:
City	:	HIXSON
State	:	TN
Zip	:	37343-5470
Country	:	US
Telephone Number	:	423-497-5355
Fax Number	:	423-308-0281

Provider Business Practice Location Address
First Line	:	9309 APISON PIKE
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363
Country	:	US
Telephone Number	:	423-551-3562
Fax Number	:	423-551-3563

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	04/05/2023

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