Individual
JACOB WINTON SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
213 W LIBERTY ST, WINNSBORO, SC 29180-1421
(803) 635-2414
Mailing address
213 W LIBERTY ST, WINNSBORO, SC 29180-1421
(803) 635-2414
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
10825
SC
Other
Enumeration date
07/01/2014
Last updated
09/01/2015
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