Provider Demographics
NPI:1760426704
Name:MORRISON, THERESA T (MD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:T
Last Name:MORRISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1077
Mailing Address - Street 2:10 ELDAD RD
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-1077
Mailing Address - Country:US
Mailing Address - Phone:931-433-2229
Mailing Address - Fax:931-433-2398
Practice Address - Street 1:10 ELDAD RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-7005
Practice Address - Country:US
Practice Address - Phone:931-433-2229
Practice Address - Fax:931-433-2398
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17103207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1043363492OtherNPI
3720044Medicare PIN
A98506Medicare UPIN