| |
102 Red Maple Trl Petal MS 39465-2678 | |
(601) 606-2554 | |
Not Available |
Full Name | |
---|---|
Speciality | Internal Medicine |
Location | 102 Red Maple Trl, Petal, Mississippi |
Authorized Official Name and Position | Geralynn G Morrison (OWNER) |
Authorized Official Contact | 6016062554 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
102 Red Maple Trl Petal MS 39465-2678 Ph: (601) 606-2554 | 102 Red Maple Trl Petal MS 39465-2678 Ph: (601) 606-2554 |
NPI Number | 1194857300 |
---|---|
Provider Enumeration Date | 03/12/2007 |
Last Update Date | 12/20/2024 |
Medicare PECOS PAC ID | 2466429626 |
---|---|
Medicare Enrollment ID | O20240930000500 |
Identifier | Type | State | Issuer |
---|---|---|---|
1194857300 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Geralynn Morrison |
---|---|
Provider Type | Practitioner - Hospitalist |
Provider Identifiers | NPI Number: 1710984539 PECOS PAC ID: 9638146897 Enrollment ID: I20120201000610 |