Basic Information
| Provider Information | |||||||||
| NPI: | 1316111453 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORRIS | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | DANIELLE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5052 W 4TH ST STE 3 | ||||||||
| Address2: | |||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394021069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012612587 | ||||||||
| FaxNumber: | 6012647426 | ||||||||
| Practice Location | |||||||||
| Address1: | 5016 S US HIGHWAY 75 | ||||||||
| Address2: | |||||||||
| City: | DENISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034164270 | ||||||||
| FaxNumber: | 9034167124 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2008 | ||||||||
| LastUpdateDate: | 06/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | P5429 | TX | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 324041801 | 05 | TX | MEDICAID | 8DV119 | 01 | TX | BCBS | OTHER |