Provider Demographics
NPI:1043363492
Name:THERESA T MORRISON MD
Entity Type:Organization
Organization Name:THERESA T MORRISON MD
Other - Org Name:STONEBRIDGE MEDICAL ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-433-2229
Mailing Address - Street 1:10 ELDAD RD
Mailing Address - Street 2:PO BOX 1077
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-7005
Mailing Address - Country:US
Mailing Address - Phone:931-433-2229
Mailing Address - Fax:931-433-2398
Practice Address - Street 1:10 ELDAD RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-7005
Practice Address - Country:US
Practice Address - Phone:931-433-2229
Practice Address - Fax:931-433-2398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17103173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3021334Medicare ID - Type UnspecifiedT MORRISON MEDICARE #
TN3021334Medicare ID - Type UnspecifiedT MORRISON MEDICARE #
TN3720044Medicare ID - Type UnspecifiedGROUP MEDICARE #
TN3720044Medicare ID - Type UnspecifiedGROUP MEDICARE #
TN3897667Medicare ID - Type UnspecifiedJ LESLIE MEDICARE #