Healthcare Provider Details

I. General information

NPI: 1548679178
Provider Name (Legal Business Name): DONALD MORGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 BURTON RD
BOONVILLE NC
27011-8609
US

IV. Provider business mailing address

1349 BURTON RD
BOONVILLE NC
27011-8609
US

V. Phone/Fax

Practice location:
  • Phone: 336-793-7959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberA4466
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: