Provider Demographics
NPI:1073134672
Name:SHAW, JOSEPH ALAN (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALAN
Last Name:SHAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22454 US HIGHWAY 72 STE 330
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613-2678
Mailing Address - Country:US
Mailing Address - Phone:256-262-6380
Mailing Address - Fax:256-262-6384
Practice Address - Street 1:22454 US HIGHWAY 72 STE 330
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35613-2678
Practice Address - Country:US
Practice Address - Phone:256-262-6380
Practice Address - Fax:256-262-6384
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL390200000X
AL44078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program