Healthcare Provider Details

I. General information

NPI: 1538679568
Provider Name (Legal Business Name): COLTON MARSHALL WILLIS MORRIS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 E MAIN ST STE 110
COLUMBUS OH
43213-2197
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 614-788-0375
  • Fax: 614-533-1993
Mailing address:
  • Phone: 614-533-6497
  • Fax: 614-788-0375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.005312RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: