Individual
DR. EDWIN HAYWOOD SHUCK III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2341 MCCALLIE AVE, PLAZA 3 SUITE 305, CHATTANOOGA, TN 37404-3239
(423) 622-2721
Mailing address
274 FRONTIER BLUFF RD, LOOKOUT MOUNTAIN, GA 30750-4160
(706) 820-0519
(706) 820-8228
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
11816
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0053980
BLUECROSS
TN
01
—
020051840
RAILROAD MEDICARE
TN
Enumeration date
05/11/2006
Last updated
02/03/2010
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