Provider Demographics
NPI:1700334547
Name:MORGAN, LILLIE
Entity Type:Individual
Prefix:
First Name:LILLIE
Middle Name:
Last Name:MORGAN
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 1:6686 COUNTY ROAD 99
Mailing Address - Street 2:
Mailing Address - City:NEWVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36353-8106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6686 COUNTY ROAD 99
Practice Address - Street 2:
Practice Address - City:NEWVILLE
Practice Address - State:AL
Practice Address - Zip Code:36353-8106
Practice Address - Country:US
Practice Address - Phone:334-791-6030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program