Healthcare Provider Details

I. General information

NPI: 1922197862
Provider Name (Legal Business Name): MICHELLE M MORRIS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 BROOKSTONE CENTRE PARKWAY
COLUMBUS GA
31904
US

IV. Provider business mailing address

2325 BROOKSTONE CENTRE PARKWAY
COLUMBUS GA
31904
US

V. Phone/Fax

Practice location:
  • Phone: 706-653-6841
  • Fax: 706-653-7843
Mailing address:
  • Phone: 706-653-6841
  • Fax: 706-653-7843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number001731
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: