Provider Demographics
NPI:1679220131
Name:MORGAN, WENDY JAMISON (PTA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:JAMISON
Last Name:MORGAN
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 1:2784 PLEASANT DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31639-6269
Mailing Address - Country:US
Mailing Address - Phone:229-349-7309
Mailing Address - Fax:
Practice Address - Street 1:2784 PLEASANT DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:GA
Practice Address - Zip Code:31639-6269
Practice Address - Country:US
Practice Address - Phone:229-349-7309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA001534225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant