Healthcare Provider Details

I. General information

NPI: 1942283270
Provider Name (Legal Business Name): GLENN SCOTT MORRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 03/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 PEABODY AVE
MEMPHIS TN
38104-4506
US

IV. Provider business mailing address

PO BOX 41527
MEMPHIS TN
38174-1527
US

V. Phone/Fax

Practice location:
  • Phone: 901-272-0003
  • Fax: 901-272-7179
Mailing address:
  • Phone: 901-272-0003
  • Fax: 901-272-7179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17025
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: