Provider Demographics
NPI:1538679568
Name:MORRIS, COLTON MARSHALL WILLIS (PA-C)
Entity Type:Individual
Prefix:
First Name:COLTON
Middle Name:MARSHALL WILLIS
Last Name:MORRIS
Suffix:
Gender:M
Credentials:PA-C
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 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:614-533-6497
Mailing Address - Fax:614-788-0375
Practice Address - Street 1:4850 E MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2197
Practice Address - Country:US
Practice Address - Phone:614-788-0375
Practice Address - Fax:614-533-1993
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-04
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005312RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0313534Medicaid