Healthcare Provider Details

I. General information

NPI: 1023443231
Provider Name (Legal Business Name): MORGAN OVERTON PHILLIPS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 01/27/2022
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 DOUG WHITE DR STE 510
MYRTLE BEACH SC
29572-4183
US

IV. Provider business mailing address

920 DOUG WHITE DR STE 510
MYRTLE BEACH SC
29572-4183
US

V. Phone/Fax

Practice location:
  • Phone: 843-497-7772
  • Fax: 843-848-7530
Mailing address:
  • Phone: 843-497-7772
  • Fax: 843-848-7530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2000
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: