Provider Demographics
NPI:1306856018
Name:MORRIS, JASON E (DPM)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:E
Last Name:MORRIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:900 CIRCLE 75 PKWY SE STE 900
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3084
Mailing Address - Country:US
Mailing Address - Phone:678-426-2171
Mailing Address - Fax:404-446-1957
Practice Address - Street 1:5445 MERIDIAN MARKS RD STE 390
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4755
Practice Address - Country:US
Practice Address - Phone:404-237-3668
Practice Address - Fax:404-237-9562
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA000990213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA769029729AMedicaid
GA202458594OtherTAX ID
800578OtherBLUE CROSS BLUE SHIELD
GA769029729AMedicaid
800578OtherBLUE CROSS BLUE SHIELD