Provider Demographics
NPI:1669859419
Name:MORGAN, MELINDA
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:MORGAN
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:PO BOX 673
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-0673
Mailing Address - Country:US
Mailing Address - Phone:404-604-4284
Mailing Address - Fax:770-961-3059
Practice Address - Street 1:1513 CLEVELAND AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6947
Practice Address - Country:US
Practice Address - Phone:404-604-4284
Practice Address - Fax:770-961-3059
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0052921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical