Kenneth Allen Shaw Jr., MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

032988 Issued in GA

Practice address

80 Newnan Station Drive, Suite a
Newnan, GA 30265

Phone

(770) 251-2060

Fax

(678) 854-9235

NPI assigned

Sep 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kenneth.shaw@westgahealth.gadirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sentry Anesthesia Management, LLC

  • Anesthesiology Physician
  • Newnan, GA
  • NPI 1134544794
  Medicare reassignment NPD
• Southern Crescent Anesthesiology, PC

  • Anesthesiology Physician
  • Lagrange, GA
  • NPI 1275585879
  NPD (past)

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429142400000",
    "number": "1780788364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 73709",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302713709",
            "telephone_number": "770-251-2060",
            "fax_number": "678-854-9235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 NEWNAN STATION DRIVE, SUITE A",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "30265",
            "telephone_number": "770-251-2060",
            "fax_number": "678-854-9235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "KENNETH",
        "middle_name": "ALLEN",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-12",
        "last_updated": "2015-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "GA",
            "license": "032988",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jared R Shafer, PA-C
• C. Steven Shaffer, PH.D., LPC
• Lillian Shakibnia, MD
• Nitika Sharma, M.D.
• Monique Sharpe
• Kevin James Sheahan, MD
• Kelly Anna Christina Sheldon
• Scott W Shelfo, M.D.
• Jeanette Shelley, RD, LD
• Kimberly W Shelnutt, OT

• Anesthesiology Physician in Newnan, GA
• Providers in Newnan, GA by specialty
• Anesthesiology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2015; 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.