Provider Demographics
NPI:1871654814
Name:MORRIS, CLELL MCLANE (DMD)
Entity Type:Individual
Prefix:
First Name:CLELL
Middle Name:MCLANE
Last Name:MORRIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 N BENNETT ST
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:GA
Mailing Address - Zip Code:31029-1977
Mailing Address - Country:US
Mailing Address - Phone:478-994-0440
Mailing Address - Fax:478-994-5004
Practice Address - Street 1:94 N BENNETT ST
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:GA
Practice Address - Zip Code:31029-1977
Practice Address - Country:US
Practice Address - Phone:478-994-0440
Practice Address - Fax:478-994-5004
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA114181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00896002AMedicaid