Provider Demographics
NPI:1114134988
Name:MORRIS, MEGAN L (ATC,OTC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:L
Last Name:MORRIS
Suffix:
Gender:F
Credentials:ATC,OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4804 HUNTERS XING
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-4940
Mailing Address - Country:US
Mailing Address - Phone:229-247-4970
Mailing Address - Fax:
Practice Address - Street 1:2109 N PATTERSON ST
Practice Address - Street 2:STE A
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2946
Practice Address - Country:US
Practice Address - Phone:229-247-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT000972225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA911255OtherBCBS OF GA