Provider Demographics
NPI:1154916468
Name:MORRIS, TOLBERT JR
Entity type:Individual
Prefix:MR
First Name:TOLBERT
Middle Name:
Last Name:MORRIS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 LAKE ROCKAWAY RD NW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3152
Mailing Address - Country:US
Mailing Address - Phone:678-607-7674
Mailing Address - Fax:866-443-8670
Practice Address - Street 1:1733 LAKE ROCKAWAY RD NW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3152
Practice Address - Country:US
Practice Address - Phone:678-607-7674
Practice Address - Fax:866-443-8670
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19627740832083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine