Provider Demographics
NPI:1518136217
Name:SHERRY D. CALLAHAN
Entity Type:Organization
Organization Name:SHERRY D. CALLAHAN
Other - Org Name:NORTH CORINTH FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:662-396-4733
Mailing Address - Street 1:383B HIGHWAY 2 NE
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-6926
Mailing Address - Country:US
Mailing Address - Phone:662-396-4733
Mailing Address - Fax:662-396-4735
Practice Address - Street 1:383B HIGHWAY 2 NE
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-6926
Practice Address - Country:US
Practice Address - Phone:662-396-4733
Practice Address - Fax:662-396-4735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA810104363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01006348Medicaid
MS427333087OtherBCBS
MS=========OtherUNITED HEALTHCARE
MS01006348Medicaid
MSQ26291Medicare UPIN