Provider Demographics
NPI:1942200431
Name:MORRISON, SIDNEY EMMETT III (MD)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:EMMETT
Last Name:MORRISON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 GATEWAY CORPORATE BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-9785
Mailing Address - Country:US
Mailing Address - Phone:803-865-4594
Mailing Address - Fax:803-865-4595
Practice Address - Street 1:114 GATEWAY CORPORATE BLVD STE 120
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-9785
Practice Address - Country:US
Practice Address - Phone:803-865-4594
Practice Address - Fax:803-865-4595
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13351208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC280001192OtherRAILROAD MEDICARE
SCTL4224Medicaid
SCP00868707OtherRAILROAD MEDICARE
SCTL4224Medicaid
SC7572Medicare PIN
SC280001192OtherRAILROAD MEDICARE