Healthcare Provider Details

I. General information

NPI: 1932171287
Provider Name (Legal Business Name): AMY FORSYTHE MORGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5370 RIDGE RD
CHARLOTTE NC
28269-0447
US

IV. Provider business mailing address

PO BOX 602344
CHARLOTTE NC
28260-2344
US

V. Phone/Fax

Practice location:
  • Phone: 704-316-1491
  • Fax:
Mailing address:
  • Phone: 704-403-3664
  • Fax: 704-403-3665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9601009
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: