Provider Demographics
NPI:1710984539
Name:MORRISON, GERALYNN G (MD)
Entity type:Individual
Prefix:
First Name:GERALYNN
Middle Name:G
Last Name:MORRISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21806208M00000X, 207R00000X
LAMD.14053R208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS2072791OtherUHC
MS6052782OtherHEALTHSPRING
MS7627279OtherAETNA
MS5732606OtherCIGNA
MS2072791OtherUHC
MS5732606OtherCIGNA
MS00124013Medicaid
MS6052782OtherHEALTHSPRING
LA4A313Medicare PIN
MS302I110460Medicare PIN