Provider Demographics
NPI:1194723965
Name:MORGAN, DENNIS P (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:P
Last Name:MORGAN
Suffix:
Gender:M
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 405827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:504 AZALEA DR
Practice Address - Street 2:SUITE A
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5397
Practice Address - Country:US
Practice Address - Phone:662-236-7738
Practice Address - Fax:662-236-9642
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11754207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00116189Medicaid
P00073141OtherRAILROAD MCR
P00073141OtherRAILROAD MCR
MSD80592Medicare UPIN