Active NPI
Jerry Emerson Shaw, PA-C
- Surgical Physician Assistant
- Memphis, TN
National Provider Identifier
1265619118
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 815
- Practice address
- 3980 New Covington Pike Ste 200
Memphis, TN 38128-2514 - Phone
- (901) 937-3232
- Fax
- (901) 373-0804
- NPI assigned
- Jan 23, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 815 | TN | Primary |
Addresses
Primary practice location
3980 New Covington Pike Ste 200
Memphis, TN 38128-2514
Mailing address
5705 Stage Rd
Ste 240
Bartlett, TN 38134-4541
Phone (901) 382-2606
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 815 | TN | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1201046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251763200000",
"number": "1265619118",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5705 STAGE RD",
"address_2": "STE 240",
"city": "BARTLETT",
"state": "TN",
"postal_code": "381344541",
"telephone_number": "901-382-2606",
"fax_number": "901-373-0809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3980 NEW COVINGTON PIKE STE 200",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381282514",
"telephone_number": "901-937-3232",
"fax_number": "901-373-0804"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "JERRY",
"middle_name": "EMERSON",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-01-23",
"last_updated": "2009-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "TN",
"license": "815",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.