Individual
BRENT MICHAEL SHAFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-2602
(706) 721-8623
(706) 721-1459
Mailing address
1120 15TH ST STE BI1056, AUGUSTA, GA 30912-0004
(706) 721-3813
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5388
GA
Other
Enumeration date
11/14/2008
Last updated
12/21/2018
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