Provider Demographics
NPI:1891136750
Name:MORRISON, RODNEY ONEAL
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:ONEAL
Last Name:MORRISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 JEFFERSON SQUARE CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1730
Mailing Address - Country:US
Mailing Address - Phone:404-210-0169
Mailing Address - Fax:
Practice Address - Street 1:3204 JEFFERSON SQUARE CT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1730
Practice Address - Country:US
Practice Address - Phone:404-210-0169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4138363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical