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Individual

JAMES B SHACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
21 E STATE ST, COLUMBUS, OH 43215-4281
(574) 546-1900
(574) 546-1999
Mailing address
PO BOX 11167, FORT WAYNE, IN 46856-1167
(574) 546-1900
(574) 546-1999

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
01045038A
IN
2084P0800X
Psychiatry Physician
04-52327
KS
2084P0800X
Psychiatry Physician
Primary
35-062208
OH
2084P0800X
Psychiatry Physician
67932
TN
2084P0800X
Psychiatry Physician
C1406
KY
2084P0800X
Psychiatry Physician
EMC0005754
MI
2084P0800X
Psychiatry Physician
MD487198C
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0934725
OH
01
DF6496
RR MEDICARE
OH
Enumeration date
09/27/2005
Last updated
01/16/2026
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