Healthcare Provider Details

I. General information

NPI: 1952655920
Provider Name (Legal Business Name): JORDAN THOMAS MORRISON PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4062 HIXSON PIKE
CHATTANOOGA TN
37415-3110
US

IV. Provider business mailing address

4062 HIXSON PIKE
CHATTANOOGA TN
37415-3110
US

V. Phone/Fax

Practice location:
  • Phone: 423-877-3568
  • Fax: 423-877-2111
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0000036778
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: