Provider Demographics
NPI:1699227876
Name:MORTON, SHIRLEY ANN
Entity Type:Individual
Prefix:MISS
First Name:SHIRLEY
Middle Name:ANN
Last Name:MORTON
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 1:8946 BENTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-4511
Mailing Address - Country:US
Mailing Address - Phone:678-519-4798
Mailing Address - Fax:
Practice Address - Street 1:188 NORTH AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3215
Practice Address - Country:US
Practice Address - Phone:678-519-4798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-03
Last Update Date:2017-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist