Healthcare Provider Details

I. General information

NPI: 1174432066
Provider Name (Legal Business Name): MORGAN DIEBOLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2968 N HIGHLAND AVE
JACKSON TN
38305-3409
US

IV. Provider business mailing address

267 HILLCREST DR
HUNTINGDON TN
38344-1501
US

V. Phone/Fax

Practice location:
  • Phone: 731-256-1819
  • Fax: 731-664-4330
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number237702
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: