Provider Demographics
NPI:1346702313
Name:BULLINGTON, MOLLY RENEE SHANKLES (MD)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:RENEE SHANKLES
Last Name:BULLINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:MOLLY
Other - Middle Name:RENEE
Other - Last Name:SHANKLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 15004
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901-5004
Mailing Address - Country:US
Mailing Address - Phone:865-541-8895
Mailing Address - Fax:865-633-4808
Practice Address - Street 1:2100 CLINCH AVENUE SUITE 410
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916
Practice Address - Country:US
Practice Address - Phone:865-343-6976
Practice Address - Fax:877-554-2891
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN716272084P0800X
IN01086041A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ096531Medicaid