Healthcare Provider Details

I. General information

NPI: 1124062617
Provider Name (Legal Business Name): WALTER SMITH MORRIS III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 MAGNOLIA SQUARE CT
ABERDEEN NC
28315-2225
US

IV. Provider business mailing address

180 MAGNOLIA SQUARE CT
ABERDEEN NC
28315-2225
US

V. Phone/Fax

Practice location:
  • Phone: 910-695-9000
  • Fax: 910-695-9015
Mailing address:
  • Phone: 910-695-9000
  • Fax: 910-695-9015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9300545
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: