Provider Demographics
NPI:1285205781
Name:SHAW, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ADAMS ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-4817
Mailing Address - Country:US
Mailing Address - Phone:478-254-0636
Mailing Address - Fax:912-525-2847
Practice Address - Street 1:400 ADAMS ST UNIT B
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-4817
Practice Address - Country:US
Practice Address - Phone:478-254-0636
Practice Address - Fax:912-525-2847
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET003277235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist