Provider Demographics
NPI:1194857300
Name:G G MORRISON LLC
Entity type:Organization
Organization Name:G G MORRISON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALYNN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-606-2554
Mailing Address - Street 1:102 RED MAPLE TRL
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-2678
Mailing Address - Country:US
Mailing Address - Phone:601-606-2554
Mailing Address - Fax:
Practice Address - Street 1:102 RED MAPLE TRL
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465-2678
Practice Address - Country:US
Practice Address - Phone:601-606-2554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1181374Medicaid
LA4A313Medicare ID - Type Unspecified
LA5CK78Medicare ID - Type Unspecified
LA1181374Medicaid
LAH37974Medicare UPIN
LAP00194555Medicare ID - Type Unspecified