Provider Demographics
NPI:1720679640
Name:LEETH, MORGAN A (CRN)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:A
Last Name:LEETH
Suffix:
Gender:F
Credentials:CRN
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PLZ STE 900
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-2643
Mailing Address - Country:US
Mailing Address - Phone:205-271-8000
Mailing Address - Fax:205-271-8050
Practice Address - Street 1:1 INDEPENDENCE PLZ STE 900
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-2643
Practice Address - Country:US
Practice Address - Phone:205-271-8000
Practice Address - Fax:205-271-8050
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1150700163WG0100X
AL1-150700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-150700OtherLICENSE NUMBER