Basic Information
Provider Information
NPI: 1790028827
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MORRIS
FirstName: JACQUELINE
MiddleName: H
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2000 PERIMETER PARK DR
Address2: STE 200
City: MORRISVILLE
State: NC
PostalCode: 275608442
CountryCode: US
TelephoneNumber: 9842154110
FaxNumber:  
Practice Location
Address1: 2400 CLINTON AVE S BLDG G
Address2:  
City: ROCHESTER
State: NY
PostalCode: 146182668
CountryCode: US
TelephoneNumber: 5853417700
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/27/2013
LastUpdateDate: 10/20/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/20/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X591141NYN Allopathic & Osteopathic PhysiciansInternal Medicine 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207RC0000X2020-00249NCY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


Home