Provider Demographics
NPI:1326199175
Name:MORFAW, CHRIS (RN)
Entity type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:
Last Name:MORFAW
Suffix:
Gender:M
Credentials:RN
Other - Prefix:MR
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:MORFAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:5219 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-4540
Mailing Address - Country:US
Mailing Address - Phone:706-729-2052
Mailing Address - Fax:706-729-2053
Practice Address - Street 1:1916 N LEG RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-4402
Practice Address - Country:US
Practice Address - Phone:706-729-2052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN141219163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN141219OtherPROFESSIONAL LICENSE