Provider Demographics
NPI:1659349314
Name:MORRIS, JOHN R III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:MORRIS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E HIGH ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-4800
Mailing Address - Country:US
Mailing Address - Phone:434-295-1444
Mailing Address - Fax:434-293-8725
Practice Address - Street 1:1100 E HIGH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-4800
Practice Address - Country:US
Practice Address - Phone:434-295-1444
Practice Address - Fax:434-293-8725
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2009-07-30
Deactivation Date:2009-06-04
Deactivation Code:
Reactivation Date:2009-07-28
Provider Licenses
StateLicense IDTaxonomies
VA0101021946174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0005315724Medicaid
VAB05956Medicare UPIN
VA0005315724Medicaid