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 |
Practice Location Phone | 662-745-6638 |
Practice Location Fax | 662-745-8480 |
Legal Business Name | SHAW FAMILY MEDICAL, LLC |
Other Organization Name | GOUGH'S FAMILY MEDICAL CLINIC |
Other Organization Name Type | Doing Business As Name |
NPI ? | 1043665532 |
Entity Type | Organization |
Enumeration Date ? | May 3, 2016 |
Last Update Date ? | May 3, 2016 |
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 |
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 |
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) |
Authorized Official Title/Position | OWNER |
Authorized Official Phone Number | 662-745-6638 |
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