Basic Information
Provider Information
NPI: 1811535255
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHAEFFER
FirstName: MORGAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1033 SAINT ANDREWS BLVD
Address2:  
City: CHARLESTON
State: SC
PostalCode: 294077156
CountryCode: US
TelephoneNumber: 8437236111
FaxNumber:  
Practice Location
Address1: 1033 SAINT ANDREWS BLVD
Address2:  
City: CHARLESTON
State: SC
PostalCode: 294077156
CountryCode: US
TelephoneNumber: 8437236111
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/17/2019
LastUpdateDate: 09/29/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/29/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XPA1538ALY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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