Basic Information
| Provider Information | |||||||||
| NPI: | 1417002965 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHERMAN | ||||||||
| FirstName: | HENRY | ||||||||
| MiddleName: | LOWELL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 S GERMANTOWN RD | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381382205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017593100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7545 AIRWAYS BLVD | ||||||||
| Address2: | |||||||||
| City: | SOUTHAVEN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386715806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017593100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 05/01/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | 2006008801 | MO | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207QS0010X | 036-100695 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207X00000X | 20669 | MS | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207QS0010X | 20669 | MS | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2006008801 | 01 | MO | MEDICAL LICENSE | OTHER | 036-100695 | 01 | IL | MEDICAL LICENSE | OTHER | 205460001 | 05 | AR | MEDICAID | Q008767 | 05 | TN | MEDICAID | 00001208 | 05 | MS | MEDICAID |