EVERETT LEE SHAW Physician Assistant License verification

Business Entity

INOPERATIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****62

License Status

INOPERATIVE

Business

First Name

EVERETT

Middle

LEE

Last Name

SHAW

Business Name

EVERETT LEE SHAW

Original Issue Date

08/22/2011

Effective Date

01/26/2022

Expiration Date

03/01/2024

City

DECATUR

State

Zip

62521

County

MACON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/06/2023