Provider Demographics
NPI:1255397915
Name:MORGAN, E ALLEN JR (PA)
Entity type:Individual
Prefix:
First Name:E
Middle Name:ALLEN
Last Name:MORGAN
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1838 AMERICAN WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-6611
Mailing Address - Country:US
Mailing Address - Phone:770-995-7622
Mailing Address - Fax:770-995-7854
Practice Address - Street 1:5665 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1764
Practice Address - Country:US
Practice Address - Phone:404-252-6104
Practice Address - Fax:404-257-1808
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2013-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA999363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA242720OtherBCBS EDI
GA970002275OtherRR MEDICARE
GA003108479BMedicaid
GA191466194AMedicaid
GA97BBBBCMedicare ID - Type UnspecifiedMEDICARE
GA003108479BMedicaid
GA242720OtherBCBS EDI