Provider Demographics
NPI:1215568852
Name:MORGAN, CHARLES FRED III
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:FRED
Last Name:MORGAN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8685 RIO SAN DIEGO DR APT 4415
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-6561
Mailing Address - Country:US
Mailing Address - Phone:219-671-2107
Mailing Address - Fax:
Practice Address - Street 1:8685 RIO SAN DIEGO DR APT 4415
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-6561
Practice Address - Country:US
Practice Address - Phone:219-671-2107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-02
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor