Provider Demographics
NPI:1710934906
Name:MORAGNE, SIDNEY (MD)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:
Last Name:MORAGNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378A CARRAIGE HOUSE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305
Mailing Address - Country:US
Mailing Address - Phone:731-300-0494
Mailing Address - Fax:731-300-0495
Practice Address - Street 1:378 CARRIAGE HOUSE DR STE A
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2254
Practice Address - Country:US
Practice Address - Phone:731-300-0494
Practice Address - Fax:731-300-0495
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN380142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE30022Medicare UPIN