# SHAW COMMUNITY CARE CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194854208
- **Authorized official:** MRS. KARLA LEE GRAVES (ADMINISTRATOR)
- **Authorized official phone:** (662) 332-8848

## Contact information

- **Practice address:** 112 PEELER AVE, SHAW, MS 38773
- **Practice address phone:** (662) 754-2060
- **Mailing address:** PO BOX 5097, GREENVILLE, MS 38704-5097
- **Mailing address phone:** (662) 332-8848

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/05/2007
- **Last updated:** 08/22/2020