Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 073150 | GA |
Y | 208600000X | Surgeon | 073150 | GA |
N | 208200000X | Surgeon | 229893 | MA |
N | 208600000X | Surgeon | 229893 | MA |
N | 2086S0102X | Surgical Critical Care | 073150 | PA |
NPI | 1265448500 |
---|---|
Provider Name | Dr. Shawn P Fagan |
First Address | Augusta, GA 30914-3726 |
Second Address | Augusta, GA 30909-1868 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 18/05/2021 |