Healthcare Provider Details

I. General information

NPI: 1073433249
Provider Name (Legal Business Name): ANTOINETTE MICHELLE MORRIS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 MONTREAL RD
TUCKER GA
30084-5203
US

IV. Provider business mailing address

5292 TASMAN TRL
LITHONIA GA
30038-2869
US

V. Phone/Fax

Practice location:
  • Phone: 770-609-8777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-358028
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: