Healthcare Provider Details

I. General information

NPI: 1225753882
Provider Name (Legal Business Name): MORGAN LYN PUTT CPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 STATE ST
CORINTH MS
38834-9307
US

IV. Provider business mailing address

240 EASTPORT ST
BURNSVILLE MS
38833-9334
US

V. Phone/Fax

Practice location:
  • Phone: 662-286-5469
  • Fax:
Mailing address:
  • Phone: 662-660-9447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number667
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: