Provider Demographics
NPI:1265448500
Name:FAGAN, SHAWN P (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:P
Last Name:FAGAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 3726
Mailing Address - Street 2:STE. 300
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30914-3726
Mailing Address - Country:US
Mailing Address - Phone:706-863-9595
Mailing Address - Fax:888-745-3917
Practice Address - Street 1:3675 J DEWEY GRAY CIR
Practice Address - Street 2:STE. 300
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1868
Practice Address - Country:US
Practice Address - Phone:706-863-9595
Practice Address - Fax:888-745-3917
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA229893208600000X
GA073150208600000X
IDM-149772086S0102X
MS237132086S0102X
NC2020-024362086S0102X
NV194602086S0102X
SCMD379352086S0102X
TNMD00000619482086S0102X
TXK52942086S0102X
VA01012688052086S0102X
PA0731502086S0102X
AK1798722086S0102X
COPA.00042592086S0102X
FLME1236882086S0102X
GA731502086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery