Healthcare Provider Details

I. General information

NPI: 1124024849
Provider Name (Legal Business Name): EUGENE BRANNON MORRIS III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 04/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1086 1/2 BAXTER ST
ATHENS GA
30606-6316
US

IV. Provider business mailing address

1086 1/2 BAXTER ST
ATHENS GA
30606-6316
US

V. Phone/Fax

Practice location:
  • Phone: 706-353-0606
  • Fax: 706-353-0798
Mailing address:
  • Phone: 706-353-0606
  • Fax: 706-353-0798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38252
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number63922
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: