Individual
MARC R SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2122 MANCHESTER EXPRESSWAY, COLUMBUS, GA 31904
(706) 320-2773
(706) 596-4226
Mailing address
PO BOX 8147, COLUMBUS, GA 31908-8147
(706) 320-2773
(706) 596-4226
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5119
GA
363AM0700X
Medical Physician Assistant
Primary
005119
GA
363AM0700X
Medical Physician Assistant
Primary
5119
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
126321
—
AL
05
—
353912753
—
GA
Enumeration date
07/16/2007
Last updated
04/30/2026
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