Healthcare Provider Details

I. General information

NPI: 1124017546
Provider Name (Legal Business Name): SHUNDA LYNETTE GARNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8613 MS HIGHWAY 12
ACKERMAN MS
39735-8917
US

IV. Provider business mailing address

278 DINKENS RD
PICKENS MS
39146-9587
US

V. Phone/Fax

Practice location:
  • Phone: 662-285-4400
  • Fax:
Mailing address:
  • Phone: 601-672-7274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16790
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: