MEDICARE: JOHN ALBERT SHULL M.D.

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	207V00000X	Obstetrics & Gynecology Physician	10078	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0024916	OTHER	TN	BCBST

General Provider Information

NPI Number	:	1942212691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ALBERT SHULL M.D.

Provider Business Mailing Address
First Line	:	929 SPRING CREEK RD
Second Line	:	SUITE 203
City	:	CHATTANOOGA
State	:	TN
Zip	:	37412-3964
Country	:	US
Telephone Number	:	423-855-0357
Fax Number	:	423-855-4917

Provider Business Practice Location Address
First Line	:	929 SPRING CREEK RD
Second Line	:	SUITE 203
City	:	CHATTANOOGA
State	:	TN
Zip	:	37412-3964
Country	:	US
Telephone Number	:	423-855-0357
Fax Number	:	423-855-4917

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	07/08/2007

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