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General NPI Number Information
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NPI Number | 1124017546
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Entity Type | Individual
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Provider Name | SHUNDA LYNETTE GARNER MD
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Gender | Female
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 8613 MS HIGHWAY 12
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City | ACKERMAN
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State | MS
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Zip | 39735-8917
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Country | US
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Telephone | 662-285-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 278 DINKENS RD
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City | PICKENS
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State | MS
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Zip | 39146-9587
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Country | US
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Telephone | 601-672-7274
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 16790
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License Number State | MS
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