Healthcare Provider Details

I. General information

NPI: 1932399276
Provider Name (Legal Business Name): SARDIS FAMILY MEDICAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 S MAIN ST
SARDIS MS
38666-1721
US

IV. Provider business mailing address

116 S MAIN ST
SARDIS MS
38666-1721
US

V. Phone/Fax

Practice location:
  • Phone: 662-487-1064
  • Fax: 662-487-1381
Mailing address:
  • Phone: 662-487-1064
  • Fax: 662-487-1381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. KIMBERLY FARROW
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 662-487-1064