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Organization
HORN LAKE FAMILY PRACTICE INC
Active
Organization
HORN LAKE FAMILY PRACTICE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHEETAL SHARMA OTHER (OFFICE MANAGER)
(662) 342-6677
Entity
Organization
Contact information
Practice address
3102 GOODMAN RD W, HORN LAKE, MS 38637-1172
(662) 342-6677
(662) 342-1213
Mailing address
3102 GOODMAN RD W, HORN LAKE, MS 38637-1172
(662) 342-6677
(662) 342-1213
Taxonomy
Speciality
Code
Description
License number
State
207QA0000X
Adolescent Medicine (Family Medicine) Physician
Primary
15476
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00118511
—
MS
05
—
9015003
—
MS
Enumeration date
09/01/2006
Last updated
07/21/2015
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