# SHAW FAMILY MEDICAL, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Shaw Family Medical
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750642633
- **Authorized official:** NORA GOUGH-DAVIS (PARTNER)
- **Authorized official phone:** (662) 754-3301

## Contact information

- **Practice address:** 112 W PEELER AVE, SHAW, MS 38773-8710
- **Practice address phone:** (662) 754-3301
- **Practice address fax:** (662) 754-3304
- **Mailing address:** PO BOX 299, SHAW, MS 38773-0299
- **Mailing address phone:** (662) 754-3301
- **Mailing address fax:** (662) 654-3304

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/06/2012
- **Last updated:** 02/22/2017