Provider Demographics
NPI:1033945035
Name:MORGAN, RODRICK
Entity type:Individual
Prefix:
First Name:RODRICK
Middle Name:
Last Name:MORGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8193 MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-7345
Mailing Address - Country:US
Mailing Address - Phone:901-307-6315
Mailing Address - Fax:901-577-7339
Practice Address - Street 1:8193 MARTIN DR
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-7345
Practice Address - Country:US
Practice Address - Phone:901-307-6315
Practice Address - Fax:901-577-7339
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider