Individual
SARA SHROCK SANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2500 NORTH STATE STREET, JACKSON, MS 39216
(601) 984-5610
(601) 984-5783
Mailing address
2500 NORTH STATE STREET, JACKSON, MS 39216
(601) 984-5610
(601) 984-5783
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
22084
MS
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
22084
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08551340
—
MS
Enumeration date
07/20/2009
Last updated
04/12/2021
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