Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 007928 | GA |
NPI | 1043650377 |
---|---|
Provider Name | Dr. F. Allen Shaw |
First Address | Midland, GA 31820-3836 |
Second Address | Midland, GA 31820-3836 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2013 |
Last Update Date | 01/07/2013 |