Provider Demographics
NPI:1538169800
Name:MORRIS, KELLY (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:HYNES
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:1600 ST JULIAN PLACE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204
Mailing Address - Country:US
Mailing Address - Phone:803-748-9994
Mailing Address - Fax:803-748-1103
Practice Address - Street 1:1600 ST JULIAN PLACE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204
Practice Address - Country:US
Practice Address - Phone:803-748-9994
Practice Address - Fax:803-748-1103
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC21911174400000X
SC21911207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1538169800OtherINDIVIDUAL NPI ENUMERATOR
SCT61885 GP3770Medicaid
SC8631Medicare PIN
SCH23565Medicare UPIN