Provider Demographics
NPI:1568686418
Name:MORGAN, JODY BRIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:BRIAN
Last Name:MORGAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4215
Mailing Address - Country:US
Mailing Address - Phone:770-227-9693
Mailing Address - Fax:770-227-8078
Practice Address - Street 1:663 S 9TH ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4215
Practice Address - Country:US
Practice Address - Phone:770-227-9693
Practice Address - Fax:770-227-8078
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0117071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice