Provider Demographics
NPI:1508357526
Name:BRANSON, MORGAN SOUTH (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:SOUTH
Last Name:BRANSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5344 HIGHWAY 174
Mailing Address - Street 2:
Mailing Address - City:DANIELSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30633-3017
Mailing Address - Country:US
Mailing Address - Phone:706-308-2652
Mailing Address - Fax:
Practice Address - Street 1:755 EPPS BRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6987
Practice Address - Country:US
Practice Address - Phone:706-979-2102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003849225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant