Healthcare Provider Details

I. General information

NPI: 1306823075
Provider Name (Legal Business Name): ELSIE COLEMAN MORRIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELSIE COLEMAN ADAMS MD

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1462 MONTREAL RD STE 214
TUCKER GA
30084
US

IV. Provider business mailing address

1462 MONTREAL RD STE 214
TUCKER GA
30084
US

V. Phone/Fax

Practice location:
  • Phone: 770-934-9210
  • Fax: 770-934-9209
Mailing address:
  • Phone: 770-934-9210
  • Fax: 770-934-9209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number023392
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number023392
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number023392
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: