Healthcare Provider Details

I. General information

NPI: 1649491010
Provider Name (Legal Business Name): JACQUELINE M TANG-MORGAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 SANDERS FERRY RD STE 203
HENDERSONVILLE TN
37075-3662
US

IV. Provider business mailing address

PO BOX 1155
HENDERSONVILLE TN
37077-1155
US

V. Phone/Fax

Practice location:
  • Phone: 615-822-1222
  • Fax: 615-822-8306
Mailing address:
  • Phone: 615-822-1222
  • Fax: 615-855-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2646
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: