Provider Demographics
NPI:1922410935
Name:MORRIS MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:MORRIS MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-739-7641
Mailing Address - Street 1:PO BOX 96164
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-0126
Mailing Address - Country:US
Mailing Address - Phone:817-739-7641
Mailing Address - Fax:817-288-0758
Practice Address - Street 1:1941 BISHOP LN
Practice Address - Street 2:#508
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1922
Practice Address - Country:US
Practice Address - Phone:817-739-7641
Practice Address - Fax:817-288-0758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-24
Last Update Date:2014-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03530208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE46850Medicare UPIN