Provider Demographics
NPI:1871657122
Name:MORRISS, SALLY A (PA-C)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:A
Last Name:MORRISS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:A
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1751 CHARLESTON WAY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-4886
Mailing Address - Country:US
Mailing Address - Phone:205-419-8200
Mailing Address - Fax:205-419-8213
Practice Address - Street 1:1751 CHARLESTON WAY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-4886
Practice Address - Country:US
Practice Address - Phone:205-419-8200
Practice Address - Fax:205-419-8213
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA389363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051556038Medicaid
AL051556038Medicaid
ALQ33989Medicare UPIN