Provider Demographics
NPI:1164460614
Name:MCGAFFIGAN, SANDY SHAW (MD)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:SHAW
Last Name:MCGAFFIGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 AUSTELL RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1103
Mailing Address - Country:US
Mailing Address - Phone:770-819-1717
Mailing Address - Fax:770-819-1140
Practice Address - Street 1:4460 AUSTELL RD
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1844
Practice Address - Country:US
Practice Address - Phone:770-941-4716
Practice Address - Fax:770-941-3047
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0409592084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA13BDFDLOtherMEDICARE ID TYPE UNSPEC
GA000704888PMedicaid
GAP00380908OtherRAILROAD MEDICARE
G26847Medicare UPIN
GA000704888PMedicaid