Healthcare Provider Details

I. General information

NPI: 1881304111
Provider Name (Legal Business Name): DANEILLE MOONEY MSN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1942 ATKINSON RD
LAWRENCEVILLE GA
30043-5003
US

IV. Provider business mailing address

PO BOX 745
LAVONIA GA
30553-0745
US

V. Phone/Fax

Practice location:
  • Phone: 678-775-0600
  • Fax:
Mailing address:
  • Phone: 770-561-1686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM08132
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: