Individual
JONATHAN SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3950 COBB PKWY NW, SUITE 703, ACWORTH, GA 30101-9532
(770) 917-0924
(770) 917-0926
Mailing address
PO BOX 242278, MONTGOMERY, AL 36124-2278
(334) 396-2110
(334) 396-4905
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTH009094
GA
Other
Enumeration date
09/21/2007
Last updated
06/30/2008
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