Provider Demographics
NPI:1619588753
Name:FESMIRE, MORGAN BLAIR
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:BLAIR
Last Name:FESMIRE
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 1:805 W MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-3429
Mailing Address - Country:US
Mailing Address - Phone:423-507-1494
Mailing Address - Fax:423-507-1565
Practice Address - Street 1:805 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3429
Practice Address - Country:US
Practice Address - Phone:423-507-1494
Practice Address - Fax:423-507-1565
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist