Provider Demographics
NPI:1962954123
Name:DEBRAD MORGAN, DPM, LLC
Entity type:Organization
Organization Name:DEBRAD MORGAN, DPM, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DPM/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:706-877-8996
Mailing Address - Street 1:PO BOX 15511
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30919-1511
Mailing Address - Country:US
Mailing Address - Phone:706-877-8996
Mailing Address - Fax:
Practice Address - Street 1:3479 SHARON RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-9539
Practice Address - Country:US
Practice Address - Phone:706-877-8996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000736213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-33113MOROtherBLUE CROSS PROVIDER NUMBER ALABAMA
AL149OtherALABAMA STATE PODIATRY LICENSE
GAPOD000736OtherGEORGIA STATE PODIATRY LICENSE
AL000033113Medicaid
AL000033113Medicaid