MEDICARE: DANIEL MOON PA

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
1	363A00000X	Physician Assistant	12305	GA

General Provider Information

NPI Number	:	1326765231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL MOON PA

Provider Business Mailing Address
First Line	:	371 E PACES FERRY RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2372
Country	:	US
Telephone Number	:	404-400-3120
Fax Number	:

Provider Business Practice Location Address
First Line	:	371 E PACES FERRY RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2372
Country	:	US
Telephone Number	:	404-400-3120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2022
Last Update Date	:	03/25/2026

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Directions to “ DANIEL MOON PA” Practice Location

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