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General NPI Number Information
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NPI Number | 1417014648
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Entity Type | Organization
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Legal Business Name | DR. TRACY MORRIS
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 01/15/2010
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Provider Practice Location Address
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Address Line | 201 TUCKER AVE
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City | RIPLEY
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State | TN
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Zip | 38063-1630
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Country | US
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Telephone | 731-635-0166
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Fax | 731-635-0167
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Provider Business Mailing Address
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Address Line | 201 TUCKER AVE
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City | RIPLEY
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State | TN
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Zip | 38063-1630
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Country | US
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Telephone | 731-635-0166
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Fax | 731-635-0167
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Authorized Official
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Title or Position | OWNER
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Name | TRACY S MORRIS
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Credential | DDS
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Telephone | 731-635-0166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS4697
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License Number State | TN
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