Provider Demographics
NPI:1770627846
Name:SHERMAN FAMILY CLINIC
Entity Type:Organization
Organization Name:SHERMAN FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:662-840-8978
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:MS
Mailing Address - Zip Code:38869-0325
Mailing Address - Country:US
Mailing Address - Phone:662-840-8978
Mailing Address - Fax:662-840-1230
Practice Address - Street 1:608 HWY 178
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:MS
Practice Address - Zip Code:38869-0325
Practice Address - Country:US
Practice Address - Phone:662-840-8978
Practice Address - Fax:662-840-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015013Medicaid
MS09015013Medicaid