MEDICARE: DR. JOHN EVANGLE MORRIS IV DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN122686	GA

General Provider Information

NPI Number	:	1982334132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN EVANGLE MORRIS IV DMD

Provider Business Mailing Address
First Line	:	1326 HIGHLAND AVE
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30904-4632
Country	:	US
Telephone Number	:	706-825-0484
Fax Number	:

Provider Business Practice Location Address
First Line	:	3702 WASHINGTON RD
Second Line	:
City	:	MARTINEZ
State	:	GA
Zip	:	30907-2848
Country	:	US
Telephone Number	:	706-863-5337
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2022
Last Update Date	:	06/12/2022

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