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General NPI Number Information
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NPI Number | 1013088186
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Entity Type | Organization
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Legal Business Name | CONVENIENT CARE OF TIDEWATER
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Dates
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Enumeration Date | 11/12/2006
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Last Update Date | 01/08/2008
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Provider Practice Location Address
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Address Line | 113 GAINSBOROUGH SQ SUITE 103
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City | CHESAPEAKE
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State | VA
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Zip | 23320-1713
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Country | US
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Telephone | 757-549-0222
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2518
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City | CHESAPEAKE
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State | VA
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Zip | 23327-2518
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Country | US
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Telephone | 757-549-0222
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANTHONY A MORRIS
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Credential | MD
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Telephone | 757-549-0222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101050282
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License Number State | VA
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