Provider Demographics
NPI:1962594481
Name:SHAVERS, TONGII L (MD)
Entity type:Individual
Prefix:
First Name:TONGII
Middle Name:L
Last Name:SHAVERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:164 WACCAMAW MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-8903
Mailing Address - Country:US
Mailing Address - Phone:843-347-4888
Mailing Address - Fax:
Practice Address - Street 1:11150 HIGHWAY 49N
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503
Practice Address - Country:US
Practice Address - Phone:228-575-1000
Practice Address - Fax:228-575-2002
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS172962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124507Medicaid
MS260000548Medicare PIN
MS00124507Medicaid