Provider Demographics
NPI:1215040381
Name:HORNE, SALLY E IV (MD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:E
Last Name:HORNE
Suffix:IV
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 SCENIC HWY
Mailing Address - Street 2:
Mailing Address - City:LOOKOUT MTN
Mailing Address - State:TN
Mailing Address - Zip Code:37350-1247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:979 E 3RD ST STE C830
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-3325
Practice Address - Country:US
Practice Address - Phone:423-778-9001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41175174400000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA107588Medicare UPIN