Provider Demographics
NPI:1366477630
Name:MORGAN, CARA MONETTE (MD)
Entity type:Individual
Prefix:DR
First Name:CARA
Middle Name:MONETTE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:MONETTE
Other - Last Name:MORGAN-DANIELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 746085
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6085
Mailing Address - Country:US
Mailing Address - Phone:773-352-1515
Mailing Address - Fax:312-929-0373
Practice Address - Street 1:4541 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-5308
Practice Address - Country:US
Practice Address - Phone:601-533-7017
Practice Address - Fax:769-333-9151
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023787207Q00000X
GA68833207Q00000X
MS25532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1696447Medicaid
LAG83679Medicare UPIN
LA5E136Medicare PIN