Shaw Family Medical, LLC
Nurse Practitioner, Family in Drew, MS. Organization (NPI-2).
NPI number1043665532
StatusActive
Last updated in NPPESMay 3, 2016
Details
- NPI
- 1043665532
- Entity type
- Organization (NPI-2)
- Legal business name
- Shaw Family Medical, LLC
- Organization subpart
- Yes
- Enumeration date
- May 3, 2016
- Last updated
- May 3, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | R872155 | MS | Yes |
Other names
- Gough'S Family Medical Clinic (Doing Business As)
Practice location
189 N Main StDrew, MS 38737-3146
Phone 662-745-6638 · Fax 662-745-8480
Mailing address
Po Box 68Drew, MS 38737-0068
Phone 662-745-6638 · Fax 662-745-8480
Authorized official
Nora Gough-Davis
Owner
6627456638
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