Provider Demographics
NPI:1134374655
Name:MORRIS, AMBER JORDAN (PA)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:JORDAN
Last Name:MORRIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 TROUPE ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4480
Mailing Address - Country:US
Mailing Address - Phone:706-737-4575
Mailing Address - Fax:706-731-5289
Practice Address - Street 1:3624 J DEWEY GRAY CIR
Practice Address - Street 2:SUITE 103
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6584
Practice Address - Country:US
Practice Address - Phone:706-651-6700
Practice Address - Fax:706-651-6189
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005497363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPA1828OtherPHYSICIAN ASSISTANT LICENSE
GA511I970666Medicare PIN