MEDICARE: MORRISON DENTAL ASSOCIATES, P.C.

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		GA

General Provider Information

NPI Number	:	1114154390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORRISON DENTAL ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	207 E 31ST ST
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31401-7304
Country	:	US
Telephone Number	:	912-232-2779
Fax Number	:	912-233-1962

Provider Business Practice Location Address
First Line	:	207 E 31ST ST
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31401-7304
Country	:	US
Telephone Number	:	912-232-2779
Fax Number	:	912-233-1962

Authorized Official
Title or Position	:	ADMINISTRATIVE ASSISTANT
Name	:	MS. VICTORIA A. MONTEITH
Credential	:
Telephone Number	:	912-235-3610

Provider Enumeration Date	:	06/16/2009
Last Update Date	:	10/15/2012

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