Individual
NICHOLAS CODY SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
201 SOUTH BROOKS AVENUE, PELAHATCHIE, MS 39145
(601) 759-5006
Mailing address
201 SOUTH BROOKS AVENUE, PELAHATCHIE, MS 39145
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0567
MS
Other
Enumeration date
01/04/2022
Last updated
01/04/2022
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