Provider Demographics
NPI:1922503770
Name:MORRIS, CLARENCE ORVILLE
Entity Type:Individual
Prefix:
First Name:CLARENCE
Middle Name:ORVILLE
Last Name:MORRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3485 BESTLAND RD
Mailing Address - Street 2:
Mailing Address - City:DUNNSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22454-2307
Mailing Address - Country:US
Mailing Address - Phone:804-238-4161
Mailing Address - Fax:804-237-0492
Practice Address - Street 1:3485 BESTLAND RD
Practice Address - Street 2:
Practice Address - City:DUNNSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22454-2307
Practice Address - Country:US
Practice Address - Phone:804-238-4161
Practice Address - Fax:804-237-0492
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA26498344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi