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General NPI Number Information
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NPI Number | 1104274323
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Entity Type | Organization
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Legal Business Name | MONAL, LLC
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Dates
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Enumeration Date | 05/27/2016
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Last Update Date | 05/31/2016
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Provider Practice Location Address
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Address Line | 1014 SYCAMORE DR SUITE B
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City | DECATUR
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State | GA
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Zip | 30030-1644
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Country | US
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Telephone | 404-299-1700
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Fax | 404-299-1616
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Provider Business Mailing Address
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Address Line | 1014 SYCAMORE DR SUITE B
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City | DECATUR
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State | GA
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Zip | 30030-1644
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Country | US
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Telephone | 404-299-1700
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Fax | 404-299-1616
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | ALEX PHILLIP SCHULTZ
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Credential | PA-C, MMSC
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Telephone | 504-239-3467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 7967
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 7967
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License Number State | GA
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