Provider Demographics
NPI:1093715641
Name:SHARMA, ACHIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ACHIN
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 138
Mailing Address - Street 2:
Mailing Address - City:HORN LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:38637-0138
Mailing Address - Country:US
Mailing Address - Phone:662-342-6677
Mailing Address - Fax:662-342-1213
Practice Address - Street 1:3102 GOODMAN RD W
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-1172
Practice Address - Country:US
Practice Address - Phone:662-342-6677
Practice Address - Fax:662-342-1213
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4162329OtherBCBS OF TN
MS00118511Medicaid
TN39191OtherUAHC
TN10030732OtherVESTICA
TN42569OtherTLC FAMILY
MSP00431450OtherMEDICARE RAILROAD
MS080015062Medicare PIN
TN39191OtherUAHC