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NPI Code Detail

MEDICARE: TYSHAWN MORTON

MEDICARE: TYSHAWN MORTON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-24-379527

General Provider Information

NPI Number : 1376360016
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYSHAWN MORTON
Provider Business Mailing Address
First Line : PO BOX 931142
Second Line :
City : ATLANTA
State : GA
Zip : 31193-1142
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3830 WASHINGTON RD STE 2
Second Line :
City : MARTINEZ
State : GA
Zip : 30907-5065
Country : US
Telephone Number : 762-222-7629
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2024
Last Update Date : 09/24/2024

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Directions to “ TYSHAWN MORTON ” Practice Location

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