Healthcare Provider Details

I. General information

NPI: 1336758531
Provider Name (Legal Business Name): MORGAN RENEE MCDERMOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 ROSWELL RD STE 140
MARIETTA GA
30062-4719
US

IV. Provider business mailing address

214 COLONIAL HOMES DR NW UNIT 1437
ATLANTA GA
30309-1587
US

V. Phone/Fax

Practice location:
  • Phone: 678-560-0011
  • Fax: 678-560-7009
Mailing address:
  • Phone: 678-451-4744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADS001039
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: