Healthcare Provider Details

I. General information

NPI: 1174621726
Provider Name (Legal Business Name): CLAYTON LEO MORGAN JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6719 GOVERNOR GC PEERY HWY
RICHLANDS VA
24641-2484
US

IV. Provider business mailing address

118 12TH STREET
PRINCETON WV
24740-2352
US

V. Phone/Fax

Practice location:
  • Phone: 276-596-6778
  • Fax:
Mailing address:
  • Phone: 304-487-7936
  • Fax: 304-431-5152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number824
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110001422
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: