Provider Demographics
NPI:1336758531
Name:MCDERMOTT, MORGAN RENEE
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:RENEE
Last Name:MCDERMOTT
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 1:214 COLONIAL HOMES DR NW UNIT 1437
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1587
Mailing Address - Country:US
Mailing Address - Phone:678-451-4744
Mailing Address - Fax:
Practice Address - Street 1:2424 ROSWELL RD STE 140
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4719
Practice Address - Country:US
Practice Address - Phone:678-560-0011
Practice Address - Fax:678-560-7009
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS001039237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist