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NPI Code Detail

MEDICARE: JOHN HARTWELL HOUSTON MOONEY M.D.

MEDICARE: JOHN HARTWELL HOUSTON MOONEY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RC0000XCardiovascular Disease PhysicianME136011FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013274158
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN HARTWELL HOUSTON MOONEY M.D.
Provider Business Mailing Address
First Line : PO BOX 746652
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6652
Country : US
Telephone Number : 904-202-2092
Fax Number : 904-376-4075
Provider Business Practice Location Address
First Line : 1250 S 18TH ST STE 202
Second Line :
City : FERNANDINA BEACH
State : FL
Zip : 32034-4729
Country : US
Telephone Number : 904-261-9786
Fax Number : 904-376-3203
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2012
Last Update Date : 12/15/2025

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