Provider Demographics
NPI:1467120949
Name:KRAUT, MORGAN DAYNE
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:DAYNE
Last Name:KRAUT
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 1:111 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3237
Mailing Address - Country:US
Mailing Address - Phone:706-767-8193
Mailing Address - Fax:
Practice Address - Street 1:4595 TOWNE LAKE PKWY BLDG 300
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5514
Practice Address - Country:US
Practice Address - Phone:678-403-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008120101YP2500X
101YP2500X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty