Healthcare Provider Details

I. General information

NPI: 1548488216
Provider Name (Legal Business Name): CHARLES MICHAEL MORLEY N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PROFESSIONAL PL SUITE 207
CARROLLTON GA
30117-3874
US

IV. Provider business mailing address

94 RED LEVEL WALK
NEWNAN GA
30265
US

V. Phone/Fax

Practice location:
  • Phone: 770-838-8367
  • Fax: 770-838-8110
Mailing address:
  • Phone: 404-547-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN114968NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: