=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407528375
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERROL MORGAN III DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2021
-----------------------------------------------------
Last Update Date | 01/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101-217 BANKS RD #121-122
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-282-3746
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 397 N CENTRAL AVE UNIT 4126
-----------------------------------------------------
City | HAPEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30354-1699
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-838-2870
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 7268
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN123002
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------