MEDICARE: JOHN MCKINLEY SHOFFNER MD

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	207SG0201X	Clinical Genetics (M.D.) Physician	032655	GA
2	207SG0202X	Clinical Biochemical Genetics Physician	032655	GA
3	207SG0203X	Clinical Molecular Genetics Physician	032655	GA
4	2084N0400X	Neurology Physician	032655	GA
5	2084P0005X	Neurodevelopmental Disabilities Physician	032655	GA

General Provider Information

NPI Number	:	1770547366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN MCKINLEY SHOFFNER MD

Provider Business Mailing Address
First Line	:	1 DUNWOODY PARK
Second Line	:	SUITE 250
City	:	ATLANTA
State	:	GA
Zip	:	30338-7404
Country	:	US
Telephone Number	:	678-225-0222
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 DUNWOODY PARK
Second Line	:	SUITE 250
City	:	ATLANTA
State	:	GA
Zip	:	30338-7404
Country	:	US
Telephone Number	:	678-225-0222
Fax Number	:

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	09/11/2025

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