Provider Demographics
NPI:1730741513
Name:MONIZ, MICHAEL PAUL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PAUL
Last Name:MONIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 FLETCHER ST
Mailing Address - Street 2:
Mailing Address - City:CEDARTOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30125-3249
Mailing Address - Country:US
Mailing Address - Phone:770-748-1500
Mailing Address - Fax:770-748-1094
Practice Address - Street 1:740 FLETCHER ST
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-3249
Practice Address - Country:US
Practice Address - Phone:770-748-1500
Practice Address - Fax:770-749-1094
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker