# HORN LAKE FAMILY PRACTICE INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508968421
- **Authorized official:** MR. SHEETAL SHARMA OTHER (OFFICE MANAGER)
- **Authorized official phone:** (662) 342-6677

## Contact information

- **Practice address:** 3102 GOODMAN RD W, HORN LAKE, MS 38637-1172
- **Practice address phone:** (662) 342-6677
- **Practice address fax:** (662) 342-1213
- **Mailing address:** 3102 GOODMAN RD W, HORN LAKE, MS 38637-1172
- **Mailing address phone:** (662) 342-6677
- **Mailing address fax:** (662) 342-1213

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0000X | Adolescent Medicine (Family Medicine) Physician | 15476 | MS | Yes |

## Other

- **Enumeration date:** 09/01/2006
- **Last updated:** 07/21/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00118511 | — | MS |
| 05 | — | 9015003 | — | MS |