Healthcare Provider Details

I. General information

NPI: 1821693177
Provider Name (Legal Business Name): ANGELA YVONNE MORTON MS, RD, CSR, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 BROOKHAVEN VIEW NE
ATLANTA GA
30319-3195
US

IV. Provider business mailing address

2108 BROOKHAVEN VIEW NE
ATLANTA GA
30319-3195
US

V. Phone/Fax

Practice location:
  • Phone: 404-735-5433
  • Fax:
Mailing address:
  • Phone: 404-735-5433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberLD004144
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD004144
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: