Covenant Family Medicine

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

COVENANT FAMILY MEDICINE

Practice address

2098 Teron Trace Suite 150
Dacula, GA 30019

Phone

(678) 730-1620

Fax

(678) 730-0858

NPI assigned

Mar 7, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Henry Song Moon, MD

Title

Partner

Phone

(678) 730-1620

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263513600000",
    "number": "1962532085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2098 TERON TRACE SUITE 150",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "30019",
            "telephone_number": "678-730-1620",
            "fax_number": "678-730-0858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2098 TERON TRACE SUITE 150",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "30019",
            "telephone_number": "678-730-1620",
            "fax_number": "678-730-0858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2010-01-15",
        "status": "A",
        "authorized_official_last_name": "MOON",
        "authorized_official_first_name": "HENRY",
        "authorized_official_middle_name": "SONG",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "678-730-1620",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alanis Corley, BCBA
• Holly Davidson Corley, M.D.
• Cornerstone Dentsitry; PC
• Cornerstone Family Practice, P.C.
• Cornerstone Pediatrics LLC
• Covenant Family Medicine GMG LLC
• Darrcelle S Covert
• Whitney Nicole Cox, RBT
• Jessica Cranford, MS,CCC-SLP
• Creative Case Management Services LLC

• Family Medicine Physician in Dacula, GA
• Providers in Dacula, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.