Individual
OLIVIA D MORAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
84 LAIRD BRINSON RD, PRENTISS, MS 39474-4237
(601) 792-4079
Mailing address
84 LAIRD BRINSON RD, PRENTISS, MS 39474-4237
(601) 792-4079
(601) 792-4079
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11394
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00019906
—
MS
01
—
080014942
RAILROAD MEDICARE
MS
01
—
1558961
AMERICAN ADMIN GROUP
MS
Enumeration date
08/20/2006
Last updated
01/03/2022
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