Provider Demographics
NPI:1003020967
Name:DENIS MORIN
Entity Type:Organization
Organization Name:DENIS MORIN
Other - Org Name:BUCHANAN MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:COGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-646-8281
Mailing Address - Street 1:30 BUCHANAN BYP
Mailing Address - Street 2:
Mailing Address - City:BUCHANAN
Mailing Address - State:GA
Mailing Address - Zip Code:30113-4924
Mailing Address - Country:US
Mailing Address - Phone:770-646-8281
Mailing Address - Fax:770-646-3579
Practice Address - Street 1:30 BUCHANAN BYP
Practice Address - Street 2:
Practice Address - City:BUCHANAN
Practice Address - State:GA
Practice Address - Zip Code:30113-4924
Practice Address - Country:US
Practice Address - Phone:770-646-8281
Practice Address - Fax:770-646-3579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024466261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
113959OtherRURAL HEALTH MEDICARE PIN
DD7682OtherRAILROAD MEDICARE PIN
GA231090380AMedicaid
113959OtherRURAL HEALTH MEDICARE PIN
GA231090380AMedicaid