Healthcare Provider Details

I. General information

NPI: 1982751848
Provider Name (Legal Business Name): CARRIE MORGAN HENDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE INGRAM MORGAN MD

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

2500 N STATE ST DEPT OF PEDIATRICS
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5214
  • Fax: 601-984-6439
Mailing address:
  • Phone: 601-984-5214
  • Fax: 601-984-6439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.093662
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number22092
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: