Provider Demographics
NPI:1063951481
Name:BOSWELL, MORGAN ALYSE (DO)
Entity type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:ALYSE
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:
Other - Last Name:HOBGOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5183
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-5183
Mailing Address - Country:US
Mailing Address - Phone:601-484-6700
Mailing Address - Fax:
Practice Address - Street 1:1800 12TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4158
Practice Address - Country:US
Practice Address - Phone:601-484-6700
Practice Address - Fax:601-703-3027
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MS28966207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program