Provider Demographics
NPI:1457679144
Name:MORRIS, OCTAVIA DECHANDRA (NP-C)
Entity Type:Individual
Prefix:MS
First Name:OCTAVIA
Middle Name:DECHANDRA
Last Name:MORRIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 TUPELO DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-2722
Mailing Address - Country:US
Mailing Address - Phone:706-561-3385
Mailing Address - Fax:
Practice Address - Street 1:146 CCA RD
Practice Address - Street 2:
Practice Address - City:LUMPKIN
Practice Address - State:GA
Practice Address - Zip Code:31815-3823
Practice Address - Country:US
Practice Address - Phone:229-838-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN165649363LF0000X
FL165649363LP0808X
GA165649363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily