Provider Demographics
NPI:1073681334
Name:ASH MORROW MEDICAL CENTER INC
Entity Type:Organization
Organization Name:ASH MORROW MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:770-961-4646
Mailing Address - Street 1:769 MORROW RD
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-3240
Mailing Address - Country:US
Mailing Address - Phone:770-961-4646
Mailing Address - Fax:404-363-4938
Practice Address - Street 1:769 MORROW RD
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-3240
Practice Address - Country:US
Practice Address - Phone:770-961-4646
Practice Address - Fax:404-363-4938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033410207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD42053Medicare UPIN
GA11BDJFMMedicare ID - Type Unspecified