Provider Demographics
NPI:1538276597
Name:MCMORAN, MICHAEL SHAWN
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SHAWN
Last Name:MCMORAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5830 BOND ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-0307
Mailing Address - Country:US
Mailing Address - Phone:404-520-3223
Mailing Address - Fax:
Practice Address - Street 1:5830 BOND ST
Practice Address - Street 2:SUITE 350
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-0307
Practice Address - Country:US
Practice Address - Phone:404-520-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR32351223P0221X
GA149471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154921608Medicaid
AR154921608Medicaid