MEDICARE: DR. K. NEAL MORRIS DDS

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	010257	GA

General Provider Information

NPI Number	:	1295922151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. K. NEAL MORRIS DDS

Provider Business Mailing Address
First Line	:	8455 HIGHWAY 85
Second Line	:	BLDG 500 SUITE 100
City	:	RIVERDALE
State	:	GA
Zip	:	30274-5115
Country	:	US
Telephone Number	:	770-478-2700
Fax Number	:

Provider Business Practice Location Address
First Line	:	8455 HIGHWAY 85
Second Line	:	BLDG 500 SUITE 100
City	:	RIVERDALE
State	:	GA
Zip	:	30274-5115
Country	:	US
Telephone Number	:	770-478-2700
Fax Number	:

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

Provider Enumeration Date	:	09/25/2007
Last Update Date	:	12/21/2007

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