Provider Demographics
NPI:1013065580
Name:MCMORRIS, GARY (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:MCMORRIS
Suffix:
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 1:950 RIVER CENTRE PL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-7320
Mailing Address - Country:US
Mailing Address - Phone:770-682-1717
Mailing Address - Fax:770-682-1723
Practice Address - Street 1:950 RIVER CENTRE PL
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-7320
Practice Address - Country:US
Practice Address - Phone:770-682-1717
Practice Address - Fax:770-682-1723
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048539207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH14976Medicare UPIN
GA11BDRSKMedicare PIN
GA582546557Medicare ID - Type Unspecified