Keith Billings Shaw, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN014607 Issued in GA

Practice address

4324 Covington Hwy
Decatur, GA 30035-1208

Phone

(404) 289-6454

NPI assigned

Jun 27, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372291200000",
    "number": "1649610130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2945 ROSEBUD RD",
            "address_2": "#420",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300528947",
            "telephone_number": "208-709-8782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4324 COVINGTON HWY",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300351208",
            "telephone_number": "404-289-6454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "KEITH",
        "middle_name": "BILLINGS",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-27",
        "last_updated": "2013-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN014607",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN014607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hana Abdullahi Shash, PA-C
• Sharon Shatil, PH.D.
• Shauna H. Mitchell DDS PC
• Adrian Loraine Shaw
• Jennifer Shaw, LCSW
• Rebecca Shaw, LPC
• Sherique Shaw
• Zoe Shaw, APC
• She Heals It LLC
• Debra A Shefter, LMT

• General Practice Dentistry in Decatur, GA
• Providers in Decatur, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.