Provider Demographics
NPI:1811976756
Name:MORGAN, EDITH MILLIE (MSN)
Entity type:Individual
Prefix:MS
First Name:EDITH
Middle Name:MILLIE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:478-745-6130
Mailing Address - Fax:478-745-4443
Practice Address - Street 1:308 COLISEUM DR
Practice Address - Street 2:SUITE #120
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3808
Practice Address - Country:US
Practice Address - Phone:478-745-6130
Practice Address - Fax:478-750-5899
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN081555363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA514845922GMedicaid
GA20250I1505OtherMEDICARE PTAN
GA514845922FMedicaid