Healthcare Provider Details

I. General information

NPI: 1922747419
Provider Name (Legal Business Name): DANIEL MORRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 PROFESSIONAL CIR STE B
MARTINEZ GA
30907-8234
US

IV. Provider business mailing address

3506 PROFESSIONAL CIR STE B
MARTINEZ GA
30907-8234
US

V. Phone/Fax

Practice location:
  • Phone: 706-210-8855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: