Provider Demographics
NPI:1306237003
Name:IVEY, MORGAN (RD, LD, CLC)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:IVEY
Suffix:
Gender:F
Credentials:RD, LD, CLC
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:A
Other - Last Name:IVEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, LD, CLC
Mailing Address - Street 1:1917 APPALOOSA MILL CIR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-6614
Mailing Address - Country:US
Mailing Address - Phone:470-222-1570
Mailing Address - Fax:
Practice Address - Street 1:2992 MAIN ST W STE 106
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5735
Practice Address - Country:US
Practice Address - Phone:470-268-4707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA86062611133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered