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Individual

AGETA MUCO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1025 MOREHEAD MEDICAL DR, SUITE 225, CHARLOTTE, NC 28204-2963
(704) 355-7150
Mailing address
PO BOX 945395, ATLANTA, GA 30394-5395
(888) 820-9533
(919) 873-9821

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1099698
NC
363A00000X
Physician Assistant
22306
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1455PA
SC
05
8102489
NC
01
P01118505
RAILROAD-MEDICARE
NC
Enumeration date
03/21/2012
Last updated
10/07/2021
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