Shaw Family Medical, Llc
Shaw Family Medical, Llc is a health care provider in Drew, MS. In this page you will find its mailing address, practice location, phone number, specialty etc.
Basic Information
| Practice Location | 189 N Main St, Drew, MS 38737-3146, US |
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| Practice Location Phone | 662-745-6638 |
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| Practice Location Fax | 662-745-8480 |
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| Legal Business Name | SHAW FAMILY MEDICAL, LLC |
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| Other Organization Name | GOUGH'S FAMILY MEDICAL CLINIC |
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| Other Organization Name Type | Doing Business As Name |
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| NPI ? | 1043665532 |
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| Entity Type | Organization |
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| Enumeration Date ? | May 3, 2016 |
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| Last Update Date ? | May 3, 2016 |
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Note:
NPI: National Provider Identifier issued to health care providers by Centers for Medicare and Medicaid Services (CMS). |
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Specialties & Licenses of Shaw Family Medical, Llc
| Specialty | Provider Type | Specialization | License | License State |
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| Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | Family | R872155 | Mississippi |
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Legacy Provider IDs of Shaw Family Medical, Llc
| Provider Id | Issuer State | Issuer Type | Issuer |
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| 04406222 | Mississippi | Medicaid | |
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Authorized Official of Shaw Family Medical, Llc
An authorized official is an appointed official with the legal authority to make changes and/or updates to the Shaw Family Medical, Llc's status and to commit the provider to fully abide by the laws and regulations relating to the National Provider Identifier (NPI).
| Authorized Official | Nora Gough-davis (FNP) |
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| Authorized Official Title/Position | OWNER |
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| Authorized Official Phone Number | 662-745-6638 |
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