NPI 1790197416 · live from the CMS NPI Registry
Shawanda Nechella Agnew, MD
Family Medicine in Southaven, MS. National Provider Identifier 1790197416, active.
NPI record
| NPI | 1790197416 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Family Medicine 207Q00000X |
| Practice location | 7736 Airways Blvd, Southaven, MS 38671 |
| Practice phone | 662-772-5222 |
| Mailing address | 3629 Williams Brooke Ln, Hernando, MS 38632 |
| Enumerated | May 29, 2014 |
| Last updated | March 22, 2024 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Medicine | 207Q00000X | 61110 (TN) |
| Family Medicine | 207Q00000X | L.4005R (AL) |
| Family Medicine primary | 207Q00000X | 24203 (MS) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.