| Shaw Family Medical | |
|
112 W Peeler Ave Shaw MS 38773-8710 | |
| (662) 754-3301 | |
| (662) 754-3304 |
| Full Name | Shaw Family Medical |
|---|---|
| Speciality | Clinic/Center |
| Location | 112 W Peeler Ave, Shaw, Mississippi |
| Authorized Official Name and Position | Nora Gough-davis (PARTNER) |
| Authorized Official Contact | 6627543301 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shaw Family Medical Po Box 299 Shaw MS 38773-0299 Ph: (662) 754-3301 | Shaw Family Medical 112 W Peeler Ave Shaw MS 38773-8710 Ph: (662) 754-3301 |
| NPI Number | 1750642633 |
|---|---|
| Provider Enumeration Date | 06/06/2012 |
| Last Update Date | 02/22/2017 |
| Medicare PECOS PAC ID | 3072769843 |
|---|---|
| Medicare Enrollment ID | O20120809000742 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750642633 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Nora C Gough-davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740410661 PECOS PAC ID: 0749322345 Enrollment ID: I20100120000411 |
| Provider Name | Corey Brown |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487944617 PECOS PAC ID: 8224281019 Enrollment ID: I20130731000215 |
| Provider Name | Lamonica Hodges |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336504513 PECOS PAC ID: 3779880331 Enrollment ID: I20160324001801 |
| Provider Name | Natayla R Pitts-thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932570074 PECOS PAC ID: 5193016822 Enrollment ID: I20160627002206 |
| Provider Name | Meta Hodges Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477090728 PECOS PAC ID: 9335413236 Enrollment ID: I20171121002982 |
| Provider Name | Clifton D Reed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912480328 PECOS PAC ID: 6406191865 Enrollment ID: I20181213001255 |
| Provider Name | Williemary Bolden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518428283 PECOS PAC ID: 4587994181 Enrollment ID: I20190925000170 |
| Provider Name | Queeneice B Ganison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437621323 PECOS PAC ID: 5799016069 Enrollment ID: I20191017001998 |
| Provider Name | Aleshia M Ford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780166876 PECOS PAC ID: 5698106201 Enrollment ID: I20200515000386 |
| Provider Name | Vanessa Haywood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700417961 PECOS PAC ID: 0547681264 Enrollment ID: I20200605000675 |
| Provider Name | Sharron S Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568002145 PECOS PAC ID: 1759700677 Enrollment ID: I20200925002537 |
| Provider Name | Regina J Evans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609416544 PECOS PAC ID: 5991124562 Enrollment ID: I20200930003267 |
| Provider Name | Tomeka R Wright Little |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609499904 PECOS PAC ID: 7315367968 Enrollment ID: I20201020001735 |
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Shaw Community Care Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 112 Peeler Ave, Shaw, MS 38773 Phone: 662-754-2060 | |
Shaw Community Care Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 112 Peeler Ave, Shaw, MS 38773 Phone: 662-332-8848 | |
Maximum Care After Hours Clinic, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 212 Highway 61, Shaw, MS 38773 Phone: 662-588-8009 | |
Making Moves In The Community, Incorporated Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 112 East Peeler Ave, Shaw, MS 38773 Phone: 662-402-1138 |