Healthcare Provider Details

I. General information

NPI: 1043885346
Provider Name (Legal Business Name): TYNESHIA MORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 05/20/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 CHATHAM ST
OGLETHOPE GA
31068-3106
US

IV. Provider business mailing address

509 CHATHAM ST
OGLETHOPE GA
31068
US

V. Phone/Fax

Practice location:
  • Phone: 478-223-3443
  • Fax:
Mailing address:
  • Phone: 678-769-0543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberS5K5Q8T3
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: