Healthcare Provider Details

I. General information

NPI: 1669578167
Provider Name (Legal Business Name): JAMES GREGORY MORRIS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2458 MEMORIAL DRIVE
WAYCROSS GA
31503
US

IV. Provider business mailing address

2458 MEMORIAL DRIVE
WAYCROSS GA
31503
US

V. Phone/Fax

Practice location:
  • Phone: 912-338-0033
  • Fax: 912-338-0048
Mailing address:
  • Phone: 912-338-0033
  • Fax: 912-338-0048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN011208
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: