Provider Demographics
NPI:1982916649
Name:MORRIS, TERRY JACK JR (DDS)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:JACK
Last Name:MORRIS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:TJ
Other - Middle Name:
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:111 E RIDGELEY ST
Mailing Address - Street 2:
Mailing Address - City:ATMORE
Mailing Address - State:AL
Mailing Address - Zip Code:36502-2013
Mailing Address - Country:US
Mailing Address - Phone:251-368-3237
Mailing Address - Fax:
Practice Address - Street 1:111 E RIDGELEY ST
Practice Address - Street 2:
Practice Address - City:ATMORE
Practice Address - State:AL
Practice Address - Zip Code:36502-2013
Practice Address - Country:US
Practice Address - Phone:251-368-3237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2011-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5750122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL121522Medicaid