Provider Demographics
NPI:1326029471
Name:MORGAN, FREDERICK DANIEL (DO)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:DANIEL
Last Name:MORGAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4759 ROCKBRIDGE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-4295
Mailing Address - Country:US
Mailing Address - Phone:404-296-3833
Mailing Address - Fax:404-501-0559
Practice Address - Street 1:4759 ROCKBRIDGE RD
Practice Address - Street 2:SUITE C
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-4295
Practice Address - Country:US
Practice Address - Phone:404-296-3833
Practice Address - Fax:404-501-0559
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA026901207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00295017AMedicaid
GA00295017AMedicaid