Provider Demographics
NPI:1215584800
Name:MORGAN, CHARITY ROSS (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:ROSS
Last Name:MORGAN
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 IVES WAY NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-6429
Mailing Address - Country:US
Mailing Address - Phone:678-925-9391
Mailing Address - Fax:
Practice Address - Street 1:300 BULLSBORO DR STE B-C
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1680
Practice Address - Country:US
Practice Address - Phone:770-683-3230
Practice Address - Fax:877-708-5261
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN170759363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner