Healthcare Provider Details

I. General information

NPI: 1225870660
Provider Name (Legal Business Name): ALEXANDRA TEDDY MORRIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 HICKORY FLAT HWY STE 200
CANTON GA
30115-3500
US

IV. Provider business mailing address

4163 ELDERBERRY DR NW
ACWORTH GA
30101-1406
US

V. Phone/Fax

Practice location:
  • Phone: 470-297-1310
  • Fax: 470-280-6579
Mailing address:
  • Phone: 404-354-3292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN269505
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN269505
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: