Provider Demographics
NPI:1235530569
Name:MORGAN, JANELLE (PA)
Entity Type:Individual
Prefix:MISS
First Name:JANELLE
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 VILLAGE CENTER BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-6706
Mailing Address - Country:US
Mailing Address - Phone:843-236-3222
Mailing Address - Fax:843-236-3005
Practice Address - Street 1:210 VILLAGE CENTER BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-6706
Practice Address - Country:US
Practice Address - Phone:843-236-3222
Practice Address - Fax:843-236-3005
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2205OtherMEDICAL LICENSE