Healthcare Provider Details

I. General information

NPI: 1659370237
Provider Name (Legal Business Name): TOMMY JOHN MORGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDICAL DR STE 705
LAGRANGE GA
30240-4130
US

IV. Provider business mailing address

300 MEDICAL DR SUITE 705
LAGRANGE GA
30240-4130
US

V. Phone/Fax

Practice location:
  • Phone: 706-885-0111
  • Fax:
Mailing address:
  • Phone: 706-885-0111
  • Fax: 706-885-0607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD 11069
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD 11069
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number057755
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number057755
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: