Healthcare Provider Details

I. General information

NPI: 1124201892
Provider Name (Legal Business Name): ROME SHERROD II MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 AIRWAYS BLVD STE B
SOUTHAVEN MS
38671-5138
US

IV. Provider business mailing address

7600 AIRWAYS BLVD STE B
SOUTHAVEN MS
38671-5138
US

V. Phone/Fax

Practice location:
  • Phone: 662-349-9370
  • Fax: 662-349-9372
Mailing address:
  • Phone: 662-349-9370
  • Fax: 662-349-9372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROME SHERROD II
Title or Position: OWNER
Credential: MD
Phone: 662-349-9370