Provider Demographics
NPI:1770111817
Name:SHAW, BRENDAN BARRETT (PA-C)
Entity type:Individual
Prefix:MR
First Name:BRENDAN
Middle Name:BARRETT
Last Name:SHAW
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:61 WHITCHER ST NE STE 4120
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1179
Mailing Address - Country:US
Mailing Address - Phone:770-424-9732
Mailing Address - Fax:770-421-0228
Practice Address - Street 1:61 WHITCHER ST NE STE 4120
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1179
Practice Address - Country:US
Practice Address - Phone:770-424-9732
Practice Address - Fax:770-421-0228
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2022-11-14
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Provider Licenses
StateLicense IDTaxonomies
GA10184363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical