Basic Information
Provider Information
NPI: 1740649771
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MORRIS
FirstName: CHRISTINE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3400C OLD MILTON PKWY STE 270
Address2:  
City: ALPHARETTA
State: GA
PostalCode: 300054438
CountryCode: US
TelephoneNumber: 7704421911
FaxNumber:  
Practice Location
Address1: 141 LACY ST NW STE 100
Address2:  
City: MARIETTA
State: GA
PostalCode: 300601117
CountryCode: US
TelephoneNumber: 7704421911
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/18/2016
LastUpdateDate: 01/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/22/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207Q00000X83165GAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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