Organization
FORMA MEDICAL AESTHETICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLARENCE ELBERT MORGAN JR. MD (MEDICAL DIRECTOR)
(770) 568-0092
Entity
Organization
Contact information
Practice address
1124 CANTON ST, ROSWELL, GA 30075-3642
(770) 568-0092
(470) 781-1339
Mailing address
1124 CANTON ST, ROSWELL, GA 30075-3642
(770) 568-0092
(470) 781-1339
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1609939834
INDIVIDUAL NPI
GA
Enumeration date
02/23/2021
Last updated
02/23/2021
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