Provider Demographics
NPI:1548258874
Name:HORN, ERICA NICOLE (MD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:NICOLE
Last Name:HORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1302 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-3419
Practice Address - Country:US
Practice Address - Phone:336-475-6139
Practice Address - Fax:336-475-3331
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01081718A207V00000X
ARE4167207V00000X
NC2023-03535207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154861001Medicaid
IN300047798Medicaid
OK200037910AMedicaid
ARI18240Medicare UPIN