Organization
SHAW FAMILY MEDICAL, LLC
Active
Parent organization
SHAW FAMILY MEDICAL, LLC
Other names
Gough's Family Medical Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
SHAW FAMILY MEDICAL, LLC
Authorized official
NORA GOUGH-DAVIS FNP (OWNER)
(662) 745-6638
Entity
Organization
Contact information
Practice address
189 N MAIN ST, DREW, MS 38737-3146
(662) 745-6638
(662) 745-8480
Mailing address
PO BOX 68, DREW, MS 38737-0068
(662) 745-6638
(662) 745-8480
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R872155
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04406222
—
MS
Enumeration date
05/03/2016
Last updated
05/03/2016
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