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General NPI Number Information
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NPI Number | 1790891687
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Entity Type | Individual
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Provider Name | JACKIE L MORGAN PA C
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Gender | Female
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5562 COUGAR TRAIL RD
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City | DUBLIN
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State | VA
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Zip | 24084-0969
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Country | US
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Telephone | 540-674-8900
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Fax | 540-674-9121
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Provider Business Mailing Address
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Address Line | PO BOX 969
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City | DUBLIN
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State | VA
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Zip | 24084-0969
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Country | US
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Telephone | 540-674-8900
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Fax | 540-674-9121
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110840575
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License Number State | VA
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