Provider Demographics
NPI:1043885346
Name:MORRIS, TYNESHIA
Entity Type:Individual
Prefix:
First Name:TYNESHIA
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 CHATHAM ST
Mailing Address - Street 2:
Mailing Address - City:OGLETHOPE
Mailing Address - State:GA
Mailing Address - Zip Code:31068
Mailing Address - Country:US
Mailing Address - Phone:678-769-0543
Mailing Address - Fax:
Practice Address - Street 1:509 CHATHAM ST
Practice Address - Street 2:
Practice Address - City:OGLETHOPE
Practice Address - State:GA
Practice Address - Zip Code:31068-3106
Practice Address - Country:US
Practice Address - Phone:478-223-3443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAS5K5Q8T3246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy