Healthcare Provider Details

I. General information

NPI: 1245409101
Provider Name (Legal Business Name): MICHAEL TYRONE MORRIS II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 LAKE HEARN DR STE 500
ATLANTA GA
30342-1570
US

IV. Provider business mailing address

1468 MONTREAL RD
TUCKER GA
30084-6901
US

V. Phone/Fax

Practice location:
  • Phone: 404-796-7011
  • Fax: 404-796-7099
Mailing address:
  • Phone: 770-638-1400
  • Fax: 678-916-4957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number232159
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number060941
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: