Provider Demographics
NPI:1215010707
Name:MORRIS, LENOX KYLE (MD)
Entity Type:Individual
Prefix:
First Name:LENOX
Middle Name:KYLE
Last Name:MORRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-0671
Mailing Address - Country:US
Mailing Address - Phone:770-267-7093
Mailing Address - Fax:770-267-7361
Practice Address - Street 1:521 GREAT OAKS DRIVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655
Practice Address - Country:US
Practice Address - Phone:770-267-7093
Practice Address - Fax:770-267-7361
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00431824CMedicaid
GA00431824CMedicaid
GAF09577Medicare UPIN