Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 63092 | TN |
NPI | 1174013825 |
---|---|
Provider Name | William Shelton JR. |
First Address | Chattanooga, TN 37403-2173 |
Second Address | Chattanooga, TN 37403-2173 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2018 |
Last Update Date | 18/10/2021 |