Provider Demographics
NPI:1104274323
Name:MONAL, LLC
Entity type:Organization
Organization Name:MONAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C, MMSC
Authorized Official - Phone:504-239-3467
Mailing Address - Street 1:1014 SYCAMORE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1644
Mailing Address - Country:US
Mailing Address - Phone:404-299-1700
Mailing Address - Fax:404-299-1616
Practice Address - Street 1:1014 SYCAMORE DR
Practice Address - Street 2:SUITE B
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1644
Practice Address - Country:US
Practice Address - Phone:404-299-1700
Practice Address - Fax:404-299-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7967363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty