Provider Demographics
NPI:1194929075
Name:MEDICAL PSYCHIATRIC ASSOCIATES P.C.
Entity type:Organization
Organization Name:MEDICAL PSYCHIATRIC ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:COLBERT
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-766-7500
Mailing Address - Street 1:6005 PARK AVE
Mailing Address - Street 2:SUITE 509
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5202
Mailing Address - Country:US
Mailing Address - Phone:901-766-7500
Mailing Address - Fax:901-766-7550
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:SUITE 509
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5202
Practice Address - Country:US
Practice Address - Phone:901-766-7500
Practice Address - Fax:901-766-7550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD8911174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3721593Medicaid
TN3721593Medicare ID - Type Unspecified
TN3721593Medicaid