Healthcare Provider Details

I. General information

NPI: 1164246419
Provider Name (Legal Business Name): CAROLYN RENEE MORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 JONESBORO RD SE
ATLANTA GA
30315-5314
US

IV. Provider business mailing address

658 LINDBERGH DR NE UNIT 1444
ATLANTA GA
30324-3667
US

V. Phone/Fax

Practice location:
  • Phone: 404-398-5318
  • Fax:
Mailing address:
  • Phone: 404-398-5318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number82580
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: