=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194880682
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EUGENE BROWN MORGAN JR. DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 SECURITY STREET
-----------------------------------------------------
City | KANNAPOLIS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28083-2757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-938-3189
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 SECURITY STREET
-----------------------------------------------------
City | KANNAPOLIS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28083-2757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-938-3189
-----------------------------------------------------
Fax | 704-938-3190
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 2971
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------