Individual
WILLIE SHAW JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ED.S. MA
Contact information
Practice address
164 WACCAMAW MEDICAL PARK DR, CONWAY, SC 29526-8903
(843) 347-5060
Mailing address
1425 TEAGUE RD APT 507, MYRTLE BEACH, SC 29577-6359
(843) 293-2976
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
07/24/2006
Last updated
07/08/2007
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