Provider Demographics
NPI:1760146864
Name:MOON, STEVEN ALLEN JR (DNP)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ALLEN
Last Name:MOON
Suffix:JR
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 RIVER COVE RD
Mailing Address - Street 2:
Mailing Address - City:SOCIAL CIRCLE
Mailing Address - State:GA
Mailing Address - Zip Code:30025-4873
Mailing Address - Country:US
Mailing Address - Phone:678-449-9047
Mailing Address - Fax:
Practice Address - Street 1:5095 MOUNT ZION PKWY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7825
Practice Address - Country:US
Practice Address - Phone:770-507-0576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA227981163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care