Provider Demographics
NPI:1922493121
Name:MOU, DANNY (MD)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:
Last Name:MOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 CLIFTON ROAD
Mailing Address - Street 2:BLDG A, 4TH FLOOR
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322
Mailing Address - Country:US
Mailing Address - Phone:404-727-5800
Mailing Address - Fax:404-778-5033
Practice Address - Street 1:1365 CLIFTON ROAD
Practice Address - Street 2:BLDG A, 4TH FLOOR
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:513-265-9845
Practice Address - Fax:404-778-5033
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
GA90993208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program