Healthcare Provider Details

I. General information

NPI: 1174087209
Provider Name (Legal Business Name): MORGAN JOSEPH CAULFIELD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 01/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 S FRONTAGE RD STE 100
VICKSBURG MS
39180-5883
US

IV. Provider business mailing address

2080 S FRONTAGE RD STE 100
VICKSBURG MS
39180-5883
US

V. Phone/Fax

Practice location:
  • Phone: 601-262-1000
  • Fax:
Mailing address:
  • Phone: 601-262-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00405
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: