Healthcare Provider Details

I. General information

NPI: 1316224553
Provider Name (Legal Business Name): GEORGE JAMES MORGAN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 WOODCOCK LN
ETNA NH
03750-4403
US

IV. Provider business mailing address

17 WOODCOCK LN
ETNA NH
03750-4403
US

V. Phone/Fax

Practice location:
  • Phone: 603-643-4461
  • Fax: 603-643-2545
Mailing address:
  • Phone: 603-643-4461
  • Fax: 603-643-2545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number042-0005712
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number5747
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: