Healthcare Provider Details

I. General information

NPI: 1770903676
Provider Name (Legal Business Name): MATTHEW LEO MORTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD NW
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

1968 PEACHTREE RD NW
ATLANTA GA
30309-1281
US

V. Phone/Fax

Practice location:
  • Phone: 404-788-1010
  • Fax:
Mailing address:
  • Phone: 404-367-3014
  • Fax: 404-367-3558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number81429
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number81429
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: