Provider Demographics
NPI:1386908713
Name:GOSS, MORGAN LACEY (DO)
Entity type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:LACEY
Last Name:GOSS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:RAINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35986-2168
Mailing Address - Country:US
Mailing Address - Phone:256-251-2566
Mailing Address - Fax:
Practice Address - Street 1:431 N CARLISLE ST
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-1733
Practice Address - Country:US
Practice Address - Phone:256-251-2566
Practice Address - Fax:256-344-8334
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO1746207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016100300Medicaid
OB4D4OtherBCBS
FLIK785ZMedicare PIN