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NPI Code Detail

MEDICARE: MR. DUANE CARSON MOODY FNP-C

MEDICARE:  MR. DUANE CARSON MOODY  FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerRN215535GA

General Provider Information

NPI Number : 1225568579
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DUANE CARSON MOODY FNP-C
Provider Business Mailing Address
First Line : 659 AUBURN AVE NE STE 156
Second Line :
City : ATLANTA
State : GA
Zip : 30312-1976
Country : US
Telephone Number : 404-888-0228
Fax Number : 404-888-0552
Provider Business Practice Location Address
First Line : 659 AUBURN AVE NE STE 156
Second Line :
City : ATLANTA
State : GA
Zip : 30312-1976
Country : US
Telephone Number : 404-888-0228
Fax Number : 404-888-0552
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2017
Last Update Date : 03/02/2020

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Directions to “ MR. DUANE CARSON MOODY FNP-C” Practice Location

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