Healthcare Provider Details

I. General information

NPI: 1336140847
Provider Name (Legal Business Name): SHERRY A. MARTIN ENDOCRINE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 GARFIELD ST
TUPELO MS
38801-6337
US

IV. Provider business mailing address

450 E PRESIDENT AVE
TUPELO MS
38801-5599
US

V. Phone/Fax

Practice location:
  • Phone: 662-840-5200
  • Fax: 662-840-8216
Mailing address:
  • Phone: 662-377-4685
  • Fax: 662-377-2755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number09923
License Number StateMS

VIII. Authorized Official

Name: SHERRY ALCORN MARTIN
Title or Position: M.D.
Credential: M.D.
Phone: 662-840-5200