Provider Demographics
NPI:1558542555
Name:MORRISON, JACK E JR (RN)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:E
Last Name:MORRISON
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 BENTON ST
Mailing Address - Street 2:# 8
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3432
Mailing Address - Country:US
Mailing Address - Phone:706-876-9015
Mailing Address - Fax:706-876-9015
Practice Address - Street 1:900 SHUGART RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2467
Practice Address - Country:US
Practice Address - Phone:706-270-5100
Practice Address - Fax:706-270-5102
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-18
Last Update Date:2007-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN#169445320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness