Provider Demographics
NPI:1689487811
Name:MIDSOUTH MEDICATION MANAGEMENT PLLC
Entity type:Organization
Organization Name:MIDSOUTH MEDICATION MANAGEMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:RAFAELA
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:901-673-3278
Mailing Address - Street 1:11180 HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:TN
Mailing Address - Zip Code:38004-4939
Mailing Address - Country:US
Mailing Address - Phone:901-673-3278
Mailing Address - Fax:
Practice Address - Street 1:8316 MACON TERRACE
Practice Address - Street 2:STE 103
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018
Practice Address - Country:US
Practice Address - Phone:901-673-3278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-30
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty