Individual
MADGE EVANS MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3000 HOSPITAL BLVD, ROSWELL, GA 30076-4915
(770) 751-2623
(770) 751-2627
Mailing address
PO BOX 105048, ATLANTA, GA 30348-5048
(770) 751-2623
(770) 751-2609
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APN1305
SC
367500000X
Certified Registered Nurse Anesthetist
RN153489
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000924712D
—
GA
05
—
000924712E
—
GA
Enumeration date
01/19/2006
Last updated
01/21/2020
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