Provider Demographics
NPI:1790320711
Name:MORGAN, RANDELL ARMOND SR (CAC II, GCADC II)
Entity Type:Individual
Prefix:
First Name:RANDELL
Middle Name:ARMOND
Last Name:MORGAN
Suffix:SR
Gender:M
Credentials:CAC II, GCADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2467 ROSEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-1555
Mailing Address - Country:US
Mailing Address - Phone:678-215-3468
Mailing Address - Fax:
Practice Address - Street 1:1194 147TH ST STE 5
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:GA
Practice Address - Zip Code:31064-8068
Practice Address - Country:US
Practice Address - Phone:678-270-8284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3027101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000000OtherI DONT HAVE ANY NUMBERS