Provider Demographics
NPI:1669526943
Name:FORDHAM, MORGAN T (DMD)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:T
Last Name:FORDHAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 S HILL ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4223
Mailing Address - Country:US
Mailing Address - Phone:770-227-1865
Mailing Address - Fax:770-227-1920
Practice Address - Street 1:317 S HILL ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4223
Practice Address - Country:US
Practice Address - Phone:770-227-1865
Practice Address - Fax:770-227-1920
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA87631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice