Healthcare Provider Details

I. General information

NPI: 1326433178
Provider Name (Legal Business Name): GSV CARE MEDICAL CLINIC OF SHERMAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 07/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 HIGHWAY 178 W SUITE 5
SHERMAN MS
38869-7000
US

IV. Provider business mailing address

P.O. BOX 302
SHERMAN MS
38869
US

V. Phone/Fax

Practice location:
  • Phone: 662-269-2151
  • Fax: 662-269-2129
Mailing address:
  • Phone: 662-269-2151
  • Fax: 662-269-2129

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: MRS. MANDA GRIFFIN
Title or Position: NURSE PRACTITIONER
Credential: DNP
Phone: 662-269-2151