Individual
MICHAEL GEORGE SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
23 PEBBLE HILL DR, BRANDON, MS 39042-2140
(601) 941-6897
Mailing address
23 PEBBLE HILL DR, BRANDON, MS 39042-2140
(601) 941-6897
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
901869
MS
Other
Enumeration date
12/29/2016
Last updated
12/29/2016
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