Healthcare Provider Details

I. General information

NPI: 1396134151
Provider Name (Legal Business Name): S&K MEDICAL,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2015
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 GOODMAN RD W
HORN LAKE MS
38637-1416
US

IV. Provider business mailing address

5885 AIRLINE RD UNIT 962
ARLINGTON TN
38002-5121
US

V. Phone/Fax

Practice location:
  • Phone: 662-253-8459
  • Fax: 662-253-8678
Mailing address:
  • Phone: 901-317-7427
  • Fax: 901-317-7585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANE FERGUSON
Title or Position: OWNER
Credential: MD
Phone: 601-942-6902