Provider Demographics
NPI:1558429175
Name:AMILDA K HORNE MD PA
Entity Type:Organization
Organization Name:AMILDA K HORNE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMILDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-403-7250
Mailing Address - Street 1:1316 MARTIN LUTHER KING JR PARKWAY
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-4606
Mailing Address - Country:US
Mailing Address - Phone:919-403-7250
Mailing Address - Fax:919-403-8950
Practice Address - Street 1:1316 MARTIN LUTHER KING JR PARKWAY
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-4606
Practice Address - Country:US
Practice Address - Phone:919-403-7250
Practice Address - Fax:919-403-8950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC391832084P0800X
LALAMD09617R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912316Medicaid
NC8943753Medicaid
NC2152673DMedicare ID - Type UnspecifiedDURHAM CO
NC8943753Medicaid
NC8912316Medicaid