Provider Demographics
NPI:1306823075
Name:MORRIS, ELSIE COLEMAN (MD)
Entity Type:Individual
Prefix:MRS
First Name:ELSIE
Middle Name:COLEMAN
Last Name:MORRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELSIE
Other - Middle Name:COLEMAN
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1462 MONTREAL RD
Mailing Address - Street 2:STE 214
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084
Mailing Address - Country:US
Mailing Address - Phone:770-934-9210
Mailing Address - Fax:770-934-9209
Practice Address - Street 1:1462 MONTREAL RD
Practice Address - Street 2:STE 214
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084
Practice Address - Country:US
Practice Address - Phone:770-934-9210
Practice Address - Fax:770-934-9209
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023392207K00000X, 208000000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00258321LMedicaid
GA202I840845Medicare UPIN
GA00258321LMedicaid
03BDBBFMedicare ID - Type Unspecified
GA511I030002Medicare UPIN
D42019Medicare UPIN