Provider Demographics
NPI:1659896264
Name:WARTHAN, MORGAN N (PA)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:N
Last Name:WARTHAN
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 1:11448 ABERNATHY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-9742
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:GATEWAY FAMILY MEDICINE
Practice Address - Street 2:406 N POINSETT HWY
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-1667
Practice Address - Country:US
Practice Address - Phone:864-834-4151
Practice Address - Fax:877-599-2593
Is Sole Proprietor?:No
Enumeration Date:2017-08-04
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC228543363AM0700X
SC2969363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3679PAMedicaid