Provider Demographics
NPI:1285993188
Name:THE SHAPPLEY CLINIC, PLLC
Entity type:Organization
Organization Name:THE SHAPPLEY CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:VANCE
Authorized Official - Last Name:SHAPPLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:901-759-0101
Mailing Address - Street 1:7705 POPLAR AVE
Mailing Address - Street 2:SUITE 310B
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3930
Mailing Address - Country:US
Mailing Address - Phone:901-759-0101
Mailing Address - Fax:901-759-1588
Practice Address - Street 1:7705 POPLAR AVE
Practice Address - Street 2:SUITE 310B
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3930
Practice Address - Country:US
Practice Address - Phone:901-759-0101
Practice Address - Fax:901-759-1588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3158201Medicare PIN