Provider Demographics
NPI:1194749150
Name:MORGAN, KERRY DEAN (MD)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:DEAN
Last Name:MORGAN
Suffix:
Gender:
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 1345
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38835-1345
Mailing Address - Country:US
Mailing Address - Phone:662-665-0151
Mailing Address - Fax:662-665-0158
Practice Address - Street 1:3035 CORDER DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-6216
Practice Address - Country:US
Practice Address - Phone:662-665-0151
Practice Address - Fax:662-665-0158
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15760207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
F70653Medicare UPIN
MS060000652Medicare ID - Type Unspecified