Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 4006-18 | MS |
Y | 213EG0000X | General Practice | 4006-18 | MS |
NPI | 1003308909 |
---|---|
Provider Name | Dr. Hayden Mckay Horan |
First Address | Grenada, MS 38901-7911 |
Second Address | Grenada, MS 38901-4600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2018 |
Last Update Date | 06/06/2018 |