Provider Demographics
NPI:1427678846
Name:MOON, SUMMER (PA-C)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1465 LANEY WALKER BLVD
Mailing Address - Street 2:AF1040
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912
Mailing Address - Country:US
Mailing Address - Phone:706-721-9619
Mailing Address - Fax:706-721-7468
Practice Address - Street 1:1465 LANEY WALKER BLVD
Practice Address - Street 2:PAVILION II, AF 1040
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0002
Practice Address - Country:US
Practice Address - Phone:706-721-3448
Practice Address - Fax:706-721-7468
Is Sole Proprietor?:No
Enumeration Date:2020-04-26
Last Update Date:2024-07-30
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9113330OtherFLORIDA PA LICENSE
SC5237OtherSOUTH CAROLINA PA LICENSE
GA12183OtherGEORGIA PA LICENSE