Healthcare Provider Details

I. General information

NPI: 1265517676
Provider Name (Legal Business Name): DARRELL MORTON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 FOOTHILLS PKWY STE 209
MARBLE HILL GA
30148-2280
US

IV. Provider business mailing address

171 FOOTHILLS PKWY
MARBLE HILL GA
30148-2278
US

V. Phone/Fax

Practice location:
  • Phone: 770-893-1904
  • Fax:
Mailing address:
  • Phone: 770-893-1904
  • Fax: 770-893-1934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN012793
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: