=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790145985
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY MORGAN PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2016
-----------------------------------------------------
Last Update Date | 12/20/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3400 OLD MILTON PKWY STE C290
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30005-6491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-667-4343
-----------------------------------------------------
Fax | 770-772-0937
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3487 S MERCY RD
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85297-0432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-222-5601
-----------------------------------------------------
Fax | 480-222-5607
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 6336
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 008307
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------