Provider Demographics
NPI:1194757096
Name:PANDIAN, SHANTHA GRACE (MD)
Entity type:Individual
Prefix:
First Name:SHANTHA
Middle Name:GRACE
Last Name:PANDIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HUNTERS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-8329
Mailing Address - Country:US
Mailing Address - Phone:423-929-1754
Mailing Address - Fax:
Practice Address - Street 1:JAMES H.QUILLEN/VAMC
Practice Address - Street 2:CORNER OF SYDNEY AND LAMONT
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:423-979-3431
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000348122084P0800X
FLME 889672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry