Provider Demographics
NPI:1992926463
Name:MORRIS DOUGLAS ALEXANDER
Entity type:Organization
Organization Name:MORRIS DOUGLAS ALEXANDER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:731-925-5555
Mailing Address - Street 1:20 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-2334
Mailing Address - Country:US
Mailing Address - Phone:731-925-5555
Mailing Address - Fax:731-925-0365
Practice Address - Street 1:20 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-2334
Practice Address - Country:US
Practice Address - Phone:731-925-5555
Practice Address - Fax:731-925-0365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0029401223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3224758Medicaid
TN28753OtherBLUE CROSS BLUE SHIELD