Healthcare Provider Details

I. General information

NPI: 1740464619
Provider Name (Legal Business Name): MRS. PHYLLIS TERRELL- MORGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 CLAIRMONT RD
DECATUR GA
30033-4004
US

IV. Provider business mailing address

9105 JIMMY LEE CIR
JONESBORO GA
30238-7015
US

V. Phone/Fax

Practice location:
  • Phone: 678-616-9000
  • Fax:
Mailing address:
  • Phone: 678-616-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: