Provider Demographics
NPI:1366485948
Name:SHAW, GEORGE PAUL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:PAUL
Last Name:SHAW
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:GA
Mailing Address - Zip Code:30728-2241
Mailing Address - Country:US
Mailing Address - Phone:706-638-5300
Mailing Address - Fax:706-638-5323
Practice Address - Street 1:611 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728-2241
Practice Address - Country:US
Practice Address - Phone:706-638-5300
Practice Address - Fax:706-638-5323
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA022056207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000233494AMedicaid
GAD46274Medicare UPIN