Provider Demographics
NPI:1023612850
Name:MORRIS, MESHA D'ANNA
Entity type:Individual
Prefix:
First Name:MESHA
Middle Name:D'ANNA
Last Name:MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-4160
Mailing Address - Country:US
Mailing Address - Phone:706-833-8297
Mailing Address - Fax:
Practice Address - Street 1:1140 14TH AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-4160
Practice Address - Country:US
Practice Address - Phone:706-833-8297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4738258821Medicaid