NPI age
19 years
Enumerated 2006-12-14
● Active
Type 1 · Individual
MR. Carlos Julio Moreno
Moreno is 1 of 3 physician assistant providers in Villa Rica and 1 of 4616 in Georgia.
Primary specialty
Physician Assistant
Plus 1 subspecialty
Licensed in
GA, FL
2 states
Status
Active
No deactivations on record
Last NPPES update
2011-12-19
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org
How this provider compares
Across 4616 active physician assistant providers in Georgia.
NPI age
19 years
↑ 11 yr above median (8 yr)
State licenses
2 states
Top 90% — 9% of peers are multi-state
Subspecialties
0
24% of peers hold subspecialties
NPI lifetime · 2006 → 2026
2006-12Enumerated in NPPES
2006
2026
Where they practice
Practice location
690 Dallas Hwy, Suite 101
Villa Rica, GA 301801264
Mailing address
690 Dallas Hwy, Suite 101
Villa Rica, GA 301801264
Specialties
-
Physician Assistant PrimaryA physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (FL) | PA9102549 | PA LICENSE |
| 05 (FL) | 292140500 | |
| 01 (GA) | 006320 | STATE LICENSE - PHYSICIAN ASSISTANT |
| 05 (GA) | PENDING |
Multi-state credentialing: Licensed in 2 states. Useful context for credentialers building cross-state provider networks.
Practice context
Part of a multi-provider practice. 16 other active providers share this practice address in NPPES.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.