Healthcare Provider Details

I. General information

NPI: 1194908046
Provider Name (Legal Business Name): AARON ROBERT MORTON ATC, LAT, EMT-B, PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 10/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE
ATLANTA GA
30322-3841
US

IV. Provider business mailing address

EMORY MIDTOWN- DAVIS FISCHER BUILDING 3RD FLOOR, ROOM 3 550 PEACHTREE STREET, N.E.
ATLANTA GA
30308
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-7858
  • Fax: 404-686-7841
Mailing address:
  • Phone: 404-686-7858
  • Fax: 404-686-7841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL2392
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10001376A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTC362
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number8539
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: