Provider Demographics
NPI:1285893933
Name:MORRIS, CARL MAYNARD JR
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:MAYNARD
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 1:3786 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-1579
Mailing Address - Country:US
Mailing Address - Phone:330-220-8810
Mailing Address - Fax:
Practice Address - Street 1:3786 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-1579
Practice Address - Country:US
Practice Address - Phone:330-220-8810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-07
Last Update Date:2008-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH181372661701172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker