Healthcare Provider Details

I. General information

NPI: 1306897665
Provider Name (Legal Business Name): SIDNEY E MORRISON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 BLANDING ST STE 102
COLUMBIA SC
29201-2967
US

IV. Provider business mailing address

PO BOX 11894
COLUMBIA SC
29211-1894
US

V. Phone/Fax

Practice location:
  • Phone: 803-748-9966
  • Fax: 803-748-7174
Mailing address:
  • Phone: 803-748-9966
  • Fax: 803-748-7174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number13351
License Number StateSC

VIII. Authorized Official

Name: MRS. NIKKI C SEXTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 803-748-9966