Individual
DR. SHAMBHAVI CHANDRAIAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2 PROFESSIONAL PARK DR STE 21, JOHNSON CITY, TN 37604-6584
(423) 379-8120
Mailing address
PO BOX 699, MOUNTAIN HOME, TN 37684-0699
(423) 439-8000
(423) 439-2200
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
52060
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00122774
—
MS
01
—
260045972
PALMETTO GBA-RAILROAD MED
MS
01
—
P00634032
RR MEDICARE
MS
05
—
Q008958
—
TN
Enumeration date
05/28/2006
Last updated
01/16/2024
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