Provider Demographics
NPI:1174998041
Name:WALTER S MORRIS III MD PLLC
Entity type:Organization
Organization Name:WALTER S MORRIS III MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:910-639-2583
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:
Mailing Address - Fax:
Practice Address - Street 1:390 SW BROAD ST
Practice Address - Street 2:UNIT 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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300545261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care