Individual
KENNETH MORRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
155 TIMBERLANE DR, FAYETTEVILLE, GA 30214-1335
(770) 461-4252
(770) 347-8802
Mailing address
155 TIMBERLANE DR, FAYETTEVILLE, GA 30214-1335
(770) 461-4252
(770) 347-8802
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
M1199
GA
Other
Enumeration date
02/01/2017
Last updated
02/01/2017
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