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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