Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 0102203670 | VA |
N | 207X00000X | Orthopaedic Surgeon | 2908 | TN |
N | 207X00000X | Orthopaedic Surgeon | 58.003128 | OH |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 2908 | TN |
NPI | 1235458183 |
---|---|
Provider Name | Dr. Shawn Patrick Mountain |
First Address | Fortson, GA 31808-0370 |
Second Address | Lebanon, TN 37090-8102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2010 |
Last Update Date | 08/06/2020 |