Provider Demographics
NPI:1710283395
Name:MORGAN, TASHEILA LARAY (CNA)
Entity Type:Individual
Prefix:MS
First Name:TASHEILA
Middle Name:LARAY
Last Name:MORGAN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:MRS
Other - First Name:TASHEILA
Other - Middle Name:LARAY
Other - Last Name:LEARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:105 PLUM ST
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032
Mailing Address - Country:US
Mailing Address - Phone:478-719-1323
Mailing Address - Fax:
Practice Address - Street 1:105 PLUM ST
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032-4328
Practice Address - Country:US
Practice Address - Phone:478-719-1323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)