Provider Demographics
NPI:1285079020
Name:SHAW, NICOLE (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 AL HIGHWAY 157 STE 300
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-0689
Mailing Address - Country:US
Mailing Address - Phone:256-737-8051
Mailing Address - Fax:256-737-8059
Practice Address - Street 1:1890 AL HIGHWAY 157 STE 300
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0689
Practice Address - Country:US
Practice Address - Phone:256-737-8051
Practice Address - Fax:256-737-8059
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL33974207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine