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 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-288-4329
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:415 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7246
Practice Address - Country:US
Practice Address - Phone:601-288-4329
Practice Address - Fax:601-288-3191
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21806208M00000X, 208M00000X
LAMD.14053R208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124013Medicaid
MS2072791OtherUHC
MSP01022235OtherRAILROAD MEDICARE
MS5732606OtherCIGNA
MS6052782OtherHEALTHSPRING
LA1181374Medicaid
MS7627279OtherAETNA
MS6052782OtherHEALTHSPRING
LA4A313Medicare PIN
MS302I110460Medicare PIN