Provider Demographics
NPI:1538662994
Name:GOSS, MORGAN (PA)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:GOSS
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 1:700 MONTGOMERY HWY STE 194
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1879
Mailing Address - Country:US
Mailing Address - Phone:205-949-1800
Mailing Address - Fax:
Practice Address - Street 1:700 MONTGOMERY HWY STE 194
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-1879
Practice Address - Country:US
Practice Address - Phone:205-949-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.1316363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical