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NPI Code Detail

MEDICARE: TRACEY SHAFFER PA

MEDICARE: TRACEY SHAFFER PA
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
1363A00000XPhysician Assistant6823GA

General Provider Information

NPI Number : 1598137564
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACEY SHAFFER PA
Provider Business Mailing Address
First Line : 1218 HARDY POINTE DR
Second Line :
City : EVANS
State : GA
Zip : 30809-5281
Country : US
Telephone Number : 706-504-4240
Fax Number :
Provider Business Practice Location Address
First Line : 1113 WASHINGTON RD
Second Line :
City : THOMSON
State : GA
Zip : 30824-7523
Country : US
Telephone Number : 706-595-7825
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2015
Last Update Date : 10/29/2015

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Directions to “ TRACEY SHAFFER PA” Practice Location

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