Provider Demographics
NPI:1821386525
Name:BURGESS, MORLEE (DO)
Entity Type:Individual
Prefix:MRS
First Name:MORLEE
Middle Name:
Last Name:BURGESS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 HOSPITAL DR STE 500
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-4020
Mailing Address - Country:US
Mailing Address - Phone:615-735-0700
Mailing Address - Fax:615-735-5480
Practice Address - Street 1:133 HOSPITAL DR STE 500
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030
Practice Address - Country:US
Practice Address - Phone:615-735-0700
Practice Address - Fax:615-735-5480
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2804207Q00000X
SC1498207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ013261Medicaid
TN10308I0357Medicare PIN
SC014987Medicaid