Provider Demographics
NPI:1447719240
Name:GOMES, MORGAN R (DC)
Entity type:Individual
Prefix:MR
First Name:MORGAN
Middle Name:R
Last Name:GOMES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 POWERS FERRY RD SE STE 100
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-7589
Mailing Address - Country:US
Mailing Address - Phone:678-549-0091
Mailing Address - Fax:
Practice Address - Street 1:134 POWERS FERRY RD SE STE 100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-7589
Practice Address - Country:US
Practice Address - Phone:678-549-0091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010076111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty