Basic Information
| Provider Information | |||||||||
| NPI: | 1194915942 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHUMATE | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | DODD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 633819 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452633819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8652923000 | ||||||||
| FaxNumber: | 8652923015 | ||||||||
| Practice Location | |||||||||
| Address1: | 4519 HIXSON PIKE | ||||||||
| Address2: | |||||||||
| City: | HIXSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373435035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238774591 | ||||||||
| FaxNumber: | 4238774225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2007 | ||||||||
| LastUpdateDate: | 09/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD43320 | TN | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 01 | TN | BCBS OF TENNESSEE | OTHER | PENDING | 05 | TN | MEDICAID | PENDING | 05 | GA | MEDICAID | PENDING | 05 | AL | MEDICAID |