Healthcare Provider Details

I. General information

NPI: 1063400695
Provider Name (Legal Business Name): BRENT S MORRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 03/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9527 W RIDGE TRAIL RD
SODDY DAISY TN
37379-4018
US

IV. Provider business mailing address

3927 WINDTREE DR
SIGNAL MTN TN
37377-1279
US

V. Phone/Fax

Practice location:
  • Phone: 423-842-3031
  • Fax: 423-842-5353
Mailing address:
  • Phone: 423-517-0544
  • Fax: 423-842-5353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number045896
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD0000012571
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: