MEDICARE: SANDY SHAW MCGAFFIGAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	040959	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13BDFDL	OTHER	GA	MEDICARE ID TYPE UNSPEC
3	P00380908	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164460614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDY SHAW MCGAFFIGAN M.D.

Provider Business Mailing Address
First Line	:	3875 AUSTELL RD
Second Line	:	SUITE 204
City	:	AUSTELL
State	:	GA
Zip	:	30106-1103
Country	:	US
Telephone Number	:	770-819-1717
Fax Number	:	770-819-1140

Provider Business Practice Location Address
First Line	:	4460 AUSTELL RD
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30106-1844
Country	:	US
Telephone Number	:	770-941-4716
Fax Number	:	770-941-3047

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	12/03/2010

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Directions to “ SANDY SHAW MCGAFFIGAN M.D.” Practice Location

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