MEDICARE: JUSTIN MORSE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	62890	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1174919401	OTHER		NPI

General Provider Information

NPI Number	:	1174919401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN MORSE M.D.

Provider Business Mailing Address
First Line	:	1724 HAMILL RD STE 102
Second Line	:
City	:	HIXSON
State	:	TN
Zip	:	37343-5098
Country	:	US
Telephone Number	:	423-267-6738
Fax Number	:	423-209-9121

Provider Business Practice Location Address
First Line	:	1724 HAMILL RD STE 102
Second Line	:
City	:	HIXSON
State	:	TN
Zip	:	37343-5098
Country	:	US
Telephone Number	:	423-267-6738
Fax Number	:	423-209-9121

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2015
Last Update Date	:	04/16/2021

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