Basic Information
| Provider Information | |||||||||
| NPI: | 1629339510 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORRIS | ||||||||
| FirstName: | TYLER | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 980 PROFESSIONAL PARK DR STE A | ||||||||
| Address2: | |||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370405251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9319051001 | ||||||||
| FaxNumber: | 9319057097 | ||||||||
| Practice Location | |||||||||
| Address1: | 980 PROFESSIONAL PARK DR STE A | ||||||||
| Address2: | |||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370405251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9319051001 | ||||||||
| FaxNumber: | 9319057097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2012 | ||||||||
| LastUpdateDate: | 08/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MT202093 | PA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 56915 | TN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0801X | 056915 | TN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma |
No ID Information.