Provider Demographics
NPI:1912286774
Name:MOON, CHRISTOPHER MICHAEL (PA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:MOON
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 418427
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8427
Mailing Address - Country:US
Mailing Address - Phone:610-644-8900
Mailing Address - Fax:484-924-0053
Practice Address - Street 1:630 13TH ST STE 250
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1017
Practice Address - Country:US
Practice Address - Phone:706-724-2500
Practice Address - Fax:706-731-5289
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2025-11-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA6214363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant