Provider Demographics
NPI:1447267265
Name:DURBIN, SHELLY V (MD)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:V
Last Name:DURBIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 440440
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0440
Mailing Address - Country:US
Mailing Address - Phone:865-670-6199
Mailing Address - Fax:865-670-6198
Practice Address - Street 1:9625 KROGER PARK DR
Practice Address - Street 2:SUITE 500
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-5880
Practice Address - Country:US
Practice Address - Phone:865-531-8100
Practice Address - Fax:865-539-0909
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD25633207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3085675Medicaid
TNF93985Medicare UPIN
TN3085678Medicare PIN