Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 207RG0100X | Internal Medicine | Gastroenterology | 20740 | TENNESSEE | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 103I502664 | OTHER | TENNESSEE | TN MEDICARE SHANNON FAIRES |
| 2 | 103I502665 | OTHER | TENNESSEE | MEDICARE DESTIN GRIFFIN TRUSSELL |
| 3 | 1538141411 | OTHER | TENNESSEE | NPI FOR JAMES S MANTON MD |
| 4 | 1649558081 | OTHER | | NPI DESTIN GRIFFIN TRUSSELL |
| 5 | 1316226616 | OTHER | | NPI SHANNON FAIRES |
| 6 | 1932181245 | OTHER | TENNESSEE | NPI FOR DONALD HETZEL, MD |
| 7 | F22939 | MEDICARE UPIN | TENNESSEE | |
| 8 | 1558343434 | OTHER | TENNESSEE | NPI FOR VIJAY PATEL, MD |
| 9 | Q29580 | MEDICARE UPIN | TENNESSEE | |
| 10 | G67410 | MEDICARE UPIN | TENNESSEE | |
| 11 | 3066362 | MEDICARE ID-TYPE UNSPECIFIED | TENNESSEE | DONALD HETZEL, MD MCARE |
| 12 | 3723922 | MEDICAID | TENNESSEE | |
| 13 | D86177 | MEDICARE UPIN | TENNESSEE | |
| 14 | 3872899 | MEDICARE ID-TYPE UNSPECIFIED | TENNESSEE | JAMES S MANTON, MD MCARE |
| 15 | 3052531 | MEDICARE ID-TYPE UNSPECIFIED | TENNESSEE | VIJAY PATEL, MD TN MCARE |
