Healthcare Provider Details

I. General information

NPI: 1629367909
Provider Name (Legal Business Name): NICHOLAS PAUL MORIN MD,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 ADAMS AVE
MEMPHIS TN
38103
US

IV. Provider business mailing address

50 N DUNLAP ST FL 3
MEMPHIS TN
38103-2800
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-7337
  • Fax: 901-287-6336
Mailing address:
  • Phone: 901-287-6303
  • Fax: 901-287-6336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number3455
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number57978
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: