Provider Demographics
NPI:1104917061
Name:BEAVERS, LANA SHARON (MD)
Entity type:Individual
Prefix:DR
First Name:LANA
Middle Name:SHARON
Last Name:BEAVERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:885 UNION ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2607
Mailing Address - Country:US
Mailing Address - Phone:931-680-1927
Mailing Address - Fax:931-684-8472
Practice Address - Street 1:885 UNION ST
Practice Address - Street 2:SUITE A
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2607
Practice Address - Country:US
Practice Address - Phone:931-680-1927
Practice Address - Fax:931-684-8472
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2021-12-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000008506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB02930Medicare UPIN
TN3162262Medicare ID - Type Unspecified