Provider Demographics
NPI:1982334132
Name:MORRIS, JOHN EVANGLE IV (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EVANGLE
Last Name:MORRIS
Suffix:IV
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 1:1326 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4632
Mailing Address - Country:US
Mailing Address - Phone:706-825-0484
Mailing Address - Fax:
Practice Address - Street 1:3702 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-2848
Practice Address - Country:US
Practice Address - Phone:706-863-5337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-12
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122686122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist