Healthcare Provider Details

I. General information

NPI: 1922608678
Provider Name (Legal Business Name): MORGAN BROOKE LEWALLEN MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 W PONCE DE LEON AVE
DECATUR GA
30030-2443
US

IV. Provider business mailing address

315 W PONCE DE LEON AVE STE 110
DECATUR GA
30030-2441
US

V. Phone/Fax

Practice location:
  • Phone: 404-537-2521
  • Fax:
Mailing address:
  • Phone: 404-312-8163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN268593
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN268593
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: