Provider Demographics
NPI:1174621726
Name:MORGAN, CLAYTON LEO JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:CLAYTON
Middle Name:LEO
Last Name:MORGAN
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2352
Mailing Address - Country:US
Mailing Address - Phone:304-487-7936
Mailing Address - Fax:304-431-5152
Practice Address - Street 1:6719 GOVERNOR GC PEERY HWY
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2484
Practice Address - Country:US
Practice Address - Phone:276-596-6778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV824207Q00000X
VA0110001422363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1174621726Medicaid
WA0053383000Medicaid
WVF09306901Medicare ID - Type UnspecifiedGR #
VA1174621726Medicare PIN
WA0053383000Medicaid
WVMOPA16133Medicare ID - Type UnspecifiedIND #