Healthcare Provider Details

I. General information

NPI: 1699837575
Provider Name (Legal Business Name): KIMBERLY G MORRIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY TACKITT M.D.

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 03/14/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 SPRING ST NE
GAINESVILLE GA
30501-3715
US

IV. Provider business mailing address

5936 ISLAND VIEW DR
BUFORD GA
30518-1330
US

V. Phone/Fax

Practice location:
  • Phone: 770-219-1553
  • Fax: 844-876-0873
Mailing address:
  • Phone: 770-317-9004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number047539
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: