Provider Demographics
NPI:1205656535
Name:THE MORTON LEGACY CENTER, LLC
Entity type:Organization
Organization Name:THE MORTON LEGACY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/FOUNDER/INVESTIGATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-213-0532
Mailing Address - Street 1:PO BOX 1631
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30061-1631
Mailing Address - Country:US
Mailing Address - Phone:404-213-0532
Mailing Address - Fax:678-653-8562
Practice Address - Street 1:500 LANIER AVE W STE 601
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7644
Practice Address - Country:US
Practice Address - Phone:404-213-0532
Practice Address - Fax:678-653-8562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management