Healthcare Provider Details

I. General information

NPI: 1639857055
Provider Name (Legal Business Name): MORGAN LEANN MATHIS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 WAYNE RD STE 101
SAVANNAH TN
38372-1598
US

IV. Provider business mailing address

1010 WAYNE RD STE 101
SAVANNAH TN
38372-1598
US

V. Phone/Fax

Practice location:
  • Phone: 731-458-2020
  • Fax: 731-458-2010
Mailing address:
  • Phone: 731-458-2020
  • Fax: 731-458-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1073P-Y
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3978
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: