Provider Demographics
NPI:1609954569
Name:SHAMBLIN, CHRISTOPHER S (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:S
Last Name:SHAMBLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 WRIGHT STREET
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-2823
Mailing Address - Country:US
Mailing Address - Phone:865-213-8595
Mailing Address - Fax:865-213-8373
Practice Address - Street 1:304 WRIGHT STREET
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TN
Practice Address - Zip Code:37874-2823
Practice Address - Country:US
Practice Address - Phone:865-213-8595
Practice Address - Fax:865-213-8373
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38965207R00000X
TNMD38965207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4234294OtherBLUE CROSS BLUE SHIELD
TN1514793Medicaid
TNI11508Medicare UPIN
TN3896934Medicare PIN