Provider Demographics
NPI:1396898144
Name:MORTON ACKER, TERRI
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:MORTON ACKER
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 1:3546 COVINGTON HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1823
Mailing Address - Country:US
Mailing Address - Phone:404-284-7744
Mailing Address - Fax:
Practice Address - Street 1:3546 COVINGTON HWY
Practice Address - Street 2:SUITE C
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1823
Practice Address - Country:US
Practice Address - Phone:404-284-7744
Practice Address - Fax:404-284-8006
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047791207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA317910OtherWELLCARE
GA000778016CMedicaid
GAP00231885OtherMEDICARE RAILROAD
GA000778016COtherPEACHSTATE
GA610247700OtherWORKER COMP
GA10046542OtherAMERIGROUP
GA10046542OtherAMERIGROUP
GA000778016CMedicaid