Healthcare Provider Details

I. General information

NPI: 1629063771
Provider Name (Legal Business Name): HENRY PHILIP MORRIS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 GAINES SCHOOL RD STE G
ATHENS GA
30605-3215
US

IV. Provider business mailing address

PO BOX 409
WATKINSVILLE GA
30677-0011
US

V. Phone/Fax

Practice location:
  • Phone: 706-543-6443
  • Fax: 706-543-8202
Mailing address:
  • Phone: 706-769-6469
  • Fax: 706-769-4402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number030353
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: