Healthcare Provider Details

I. General information

NPI: 1518459049
Provider Name (Legal Business Name): SAMUEL CASEY MORRISON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVE NW
WASHINGTON DC
20059
US

IV. Provider business mailing address

2987 DISTRICT AVE APT 517
FAIRFAX VA
22031-1537
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-6100
  • Fax:
Mailing address:
  • Phone: 571-218-2891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA09119529
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA031489
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: