Healthcare Provider Details

I. General information

NPI: 1689770414
Provider Name (Legal Business Name): DENIS MORIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 BUCHANAN BYP
BUCHANAN GA
30113-4924
US

IV. Provider business mailing address

30 BUCHANAN BYP
BUCHANAN GA
30113-4924
US

V. Phone/Fax

Practice location:
  • Phone: 770-646-8281
  • Fax: 770-646-3579
Mailing address:
  • Phone: 770-646-8281
  • Fax: 770-646-3579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number024466
License Number StateGA

VIII. Authorized Official

Name: MRS. MELANIE D COGGINS
Title or Position: OFFICE MANAGER
Credential:
Phone: 770-824-2854