Provider Demographics
NPI:1770506578
Name:MORRIS, WAYNE SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:SAMUEL
Last Name:MORRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:270 HAWTHORNE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2881
Mailing Address - Country:US
Mailing Address - Phone:706-546-5700
Mailing Address - Fax:706-546-1274
Practice Address - Street 1:270 HAWTHORNE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2881
Practice Address - Country:US
Practice Address - Phone:706-546-5700
Practice Address - Fax:706-546-1274
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019733207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00160432BMedicaid
GA00160432BMedicaid