Provider Demographics
NPI:1215973490
Name:MORGAN, JACK COLBERT III (MD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:COLBERT
Last Name:MORGAN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6005 PARK AVENUE
Mailing Address - Street 2:SUITE 509
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119
Mailing Address - Country:US
Mailing Address - Phone:901-766-7500
Mailing Address - Fax:901-766-7550
Practice Address - Street 1:6005 PARK AVENUE
Practice Address - Street 2:SUITE 509
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119
Practice Address - Country:US
Practice Address - Phone:901-766-7500
Practice Address - Fax:901-766-7550
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD89112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3721593Medicaid
TN2006300OtherBLUE CROSS BLUE SHIELD
TN2006300OtherBLUE CROSS BLUE SHIELD
B02726Medicare UPIN