Provider Demographics
NPI:1124062617
Name:MORRIS, WALTER S III (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:S
Last Name:MORRIS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 SW BROAD ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-5407
Mailing Address - Country:US
Mailing Address - Phone:910-639-2583
Mailing Address - Fax:
Practice Address - Street 1:390 SW BROAD ST
Practice Address - Street 2:UNITE A
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-5407
Practice Address - Country:US
Practice Address - Phone:910-639-2583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300545207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC60821OtherBC/BS NC PROVIDER#
NC80156OtherMEDCOST PROVIDER#
NCFH1000225OtherFIRSTCAROLINACARE PROV.#
SCN00541OtherSC MEDICAID PROVIDER#
NC110106123OtherPALMETTO GBA PROVIDER#
NC8960821Medicaid
NC0403885OtherEVERCARE
F66732Medicare UPIN
SCN00541OtherSC MEDICAID PROVIDER#