Individual
MICAELA MOEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
275 COLLIER RD NW STE 470, ATLANTA, GA 30309-1711
(404) 351-1002
Mailing address
840 FREDERICA ST NE, ATLANTA, GA 30306-4704
(214) 636-4705
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
96787
GA
208600000X
Surgery Physician
D0094099
MD
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/01/2016
Last updated
10/18/2023
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