Healthcare Provider Details

I. General information

NPI: 1285893933
Provider Name (Legal Business Name): CARL MAYNARD MORRIS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2008
Last Update Date: 06/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3786 MAGNOLIA DR
BRUNSWICK OH
44212-1579
US

IV. Provider business mailing address

3786 MAGNOLIA DR
BRUNSWICK OH
44212-1579
US

V. Phone/Fax

Practice location:
  • Phone: 330-220-8810
  • Fax:
Mailing address:
  • Phone: 330-220-8810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number181372661701
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: