Provider Demographics
NPI:1356343727
Name:DAVOUDI, R. MORGAN (MD)
Entity type:Individual
Prefix:DR
First Name:R. MORGAN
Middle Name:
Last Name:DAVOUDI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3855 PLEASANT HILL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1407
Mailing Address - Country:US
Mailing Address - Phone:770-418-1234
Mailing Address - Fax:770-817-1110
Practice Address - Street 1:3855 PLEASANT HILL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1407
Practice Address - Country:US
Practice Address - Phone:770-418-1234
Practice Address - Fax:770-817-1110
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2015-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAGA45060208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA24BCBWMMedicare PIN