Active NPI
Jonathan Shaw
- Physical Therapist
- Acworth, GA
National Provider Identifier
1073709143
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PTH009094
- Practice address
- 3950 Cobb Pkwy NW
Suite 703
Acworth, GA 30101-9532 - Phone
- (770) 917-0924
- Fax
- (770) 917-0926
- NPI assigned
- Sep 21, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PTH009094 | GA | Primary |
Addresses
Primary practice location
3950 Cobb Pkwy NW
Suite 703
Acworth, GA 30101-9532
Mailing address
PO Box 242278
Montgomery, AL 36124-2278
Phone (334) 396-2110
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTH009094 | GA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emory Physical Therapy, LLC | Past | Accepting new patients | |
| PT Solutions of Acworth LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapy Clinic/Center
- Duluth, GA
- NPI 1831108695
-
- Physical Therapist
- Augusta, GA
- NPI 1518435189
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214784000000",
"number": "1073709143",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 242278",
"city": "MONTGOMERY",
"state": "AL",
"postal_code": "361242278",
"telephone_number": "334-396-2110",
"fax_number": "334-396-4905"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3950 COBB PKWY NW",
"address_2": "SUITE 703",
"city": "ACWORTH",
"state": "GA",
"postal_code": "301019532",
"telephone_number": "770-917-0924",
"fax_number": "770-917-0926"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "JONATHAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-09-21",
"last_updated": "2008-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PTH009094",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Acworth, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.