Provider Demographics
NPI:1326140799
Name:MORRIS, JOHNNIE E (DC)
Entity Type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:E
Last Name:MORRIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1169
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38902-1169
Mailing Address - Country:US
Mailing Address - Phone:662-229-0690
Mailing Address - Fax:662-229-0352
Practice Address - Street 1:1332 SUNSET DR
Practice Address - Street 2:SUITE A
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4000
Practice Address - Country:US
Practice Address - Phone:662-229-0690
Practice Address - Fax:662-229-0352
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0995111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS3051083001OtherCIGNA HEALTHCARE
MS00122244Medicaid
MS3051083001OtherCIGNA HEALTHCARE
MS00122244Medicaid