Basic Information
Provider Information
NPI: 1821552894
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MORRELL
FirstName: ZACHARY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1321 MURFREESBORO PIKE STE 702
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372172679
CountryCode: US
TelephoneNumber: 6157244722
FaxNumber:  
Practice Location
Address1: 2460 INDIA HOOK RD STE 104-105
Address2:  
City: ROCK HILL
State: SC
PostalCode: 297323530
CountryCode: US
TelephoneNumber: 8033666250
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/24/2019
LastUpdateDate: 01/24/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000XRBT-17-39659 Y    

No ID Information.


Home