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General NPI Number Information
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NPI Number | 1437424660
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Entity Type | Individual
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Provider Name | AGETA MUCO PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/21/2012
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Last Update Date | 10/07/2021
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Provider Practice Location Address
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Address Line | 1025 MOREHEAD MEDICAL DR SUITE 225
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City | CHARLOTTE
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State | NC
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Zip | 28204-2963
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Country | US
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Telephone | 704-355-7150
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 945395
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City | ATLANTA
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State | GA
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Zip | 30394-5395
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Country | US
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Telephone | 888-820-9533
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Fax | 919-873-9821
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 22306
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1099698
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License Number State | NC
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