Provider Demographics
NPI:1932171287
Name:MORGAN, AMY FORSYTHE (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:FORSYTHE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MD
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 602344
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2344
Mailing Address - Country:US
Mailing Address - Phone:704-403-3664
Mailing Address - Fax:704-403-3665
Practice Address - Street 1:5370 RIDGE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0447
Practice Address - Country:US
Practice Address - Phone:704-316-1491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601009208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC160722OtherWELLPATH
NC18408OtherPARTNERS MEDICARE CHOICE
NC1932171287Medicaid
NC8960148Medicaid
NC65665OtherMEDCOST
NC844277OtherMAMSI
NC566000156OtherPRACTICE TAX ID
NC5988187OtherAETNA
NC60148OtherBCBS
SCNC2056Medicaid
NCG29981Medicare UPIN
NC1932171287Medicaid
NCNCG980AMedicare PIN