Provider Demographics
NPI:1902023278
Name:PRICE, SHAWN L (MD)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:L
Last Name:PRICE
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 1:6029 WALNUT GROVE RD STE 403
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2112
Mailing Address - Country:US
Mailing Address - Phone:901-261-7836
Mailing Address - Fax:901-226-0215
Practice Address - Street 1:6029 WALNUT GROVE RD STE 403
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2112
Practice Address - Country:US
Practice Address - Phone:901-261-7836
Practice Address - Fax:901-226-0215
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN66807207X00000X
KY44699207X00000X
MS30677207X00000X
IN01069818A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100181080Medicaid
IN201040330Medicaid
TNQ077594Medicaid
KY50034878OtherPASSPORT