Provider Demographics
NPI:1437424660
Name:MUCO, AGETA (PA-C)
Entity Type:Individual
Prefix:
First Name:AGETA
Middle Name:
Last Name:MUCO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 945395
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-5395
Mailing Address - Country:US
Mailing Address - Phone:888-820-9533
Mailing Address - Fax:919-873-9821
Practice Address - Street 1:1025 MOREHEAD MEDICAL DR
Practice Address - Street 2:SUITE 225
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2963
Practice Address - Country:US
Practice Address - Phone:704-355-7150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22306363A00000X
NC1099698363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1455PAMedicaid
NC8102489Medicaid
NCP01118505OtherRAILROAD-MEDICARE
NCP01118505OtherRAILROAD-MEDICARE
NCNC6470AMedicare PIN