Healthcare Provider Details

I. General information

NPI: 1982916649
Provider Name (Legal Business Name): TERRY JACK MORRIS JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TJ MORRIS DDS

II. Dates (important events)

Enumeration Date: 07/10/2010
Last Update Date: 11/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E RIDGELEY ST
ATMORE AL
36502-2013
US

IV. Provider business mailing address

111 E RIDGELEY ST
ATMORE AL
36502-2013
US

V. Phone/Fax

Practice location:
  • Phone: 251-368-3237
  • Fax:
Mailing address:
  • Phone: 251-368-3237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5750
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: