Provider Demographics
NPI:1225192388
Name:SHAW, THOMAS GEORGE JR (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GEORGE
Last Name:SHAW
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POST OFFICE BOX 1295
Mailing Address - Street 2:1301 HIGHWAY 441 SOUTH
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-0022
Mailing Address - Country:US
Mailing Address - Phone:706-754-8561
Mailing Address - Fax:706-754-8561
Practice Address - Street 1:1301 HIGHWAY 441 SOUTH
Practice Address - Street 2:
Practice Address - City:CLARKESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30523-0022
Practice Address - Country:US
Practice Address - Phone:706-754-8561
Practice Address - Fax:706-754-8561
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCBJLMedicare ID - Type Unspecified
GAU28246Medicare UPIN