Provider Demographics
NPI:1124023452
Name:SHAFFER, DON W (MD)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:W
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:531 ROSELANE ST NW STE 710
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-6975
Mailing Address - Country:US
Mailing Address - Phone:678-331-3297
Mailing Address - Fax:678-581-7187
Practice Address - Street 1:340 KENNESTONE HOSPITAL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1158
Practice Address - Country:US
Practice Address - Phone:770-281-5100
Practice Address - Fax:678-581-7100
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA037681207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00594591FMedicaid
GA00594591CMedicaid
GA00594591HMedicaid
GA00594591EMedicaid
GA1124023452OtherNPI NUMBER
GA00594591JMedicaid
GA00594591DMedicaid
GA00594591JMedicaid