Healthcare Provider Details

I. General information

NPI: 1750215042
Provider Name (Legal Business Name): MALACHI ZOE MORRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 LAKE HARBOUR DR APT 305
RIDGELAND MS
39157-1065
US

IV. Provider business mailing address

959 LAKE HARBOUR DR APT 305
RIDGELAND MS
39157-1065
US

V. Phone/Fax

Practice location:
  • Phone: 601-968-2059
  • Fax:
Mailing address:
  • Phone: 601-968-2059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: