Active NPI
Marcus Antwone Moon
- Neonatal/Pediatric Registered Respiratory Therapist
- Conyers, GA
National Provider Identifier
1104334275
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neonatal/Pediatric Registered Respiratory Therapist
- License
- 007330
- Practice address
- 1825 Parker Rd SE Apt 105
Conyers, GA 30094-2644 - Phone
- (404) 547-9678
- NPI assigned
- Jan 11, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neonatal/Pediatric Registered Respiratory Therapist | 2279P3900X | 007330 | GA | Primary |
Addresses
Primary practice location
1825 Parker Rd SE Apt 105
Conyers, GA 30094-2644
Mailing address
1825 Parker Rd SE Apt 105
Conyers, GA 30094-2644
Phone (404) 547-9678
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 007330 | GA | MD | Neonatal/Pediatric Registered Respiratory Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1515628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1515628800000",
"number": "1104334275",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1825 PARKER RD SE APT 105",
"city": "CONYERS",
"state": "GA",
"postal_code": "300942644",
"telephone_number": "404-547-9678"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1825 PARKER RD SE APT 105",
"city": "CONYERS",
"state": "GA",
"postal_code": "300942644",
"telephone_number": "404-547-9678"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOON",
"first_name": "MARCUS",
"middle_name": "ANTWONE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-01-11",
"last_updated": "2018-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "2279P3900X",
"taxonomy_group": "",
"desc": "Respiratory Therapist, Registered, Neonatal/Pediatrics",
"state": "GA",
"license": "007330",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conyers, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.