Healthcare Provider Details

I. General information

NPI: 1710907670
Provider Name (Legal Business Name): STANLEY J MOYE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 PALMYRA RD
ALBANY GA
31701-1319
US

IV. Provider business mailing address

2101 PALMYRA RD
ALBANY GA
31701-1319
US

V. Phone/Fax

Practice location:
  • Phone: 229-889-1021
  • Fax: 229-889-1521
Mailing address:
  • Phone: 229-889-1021
  • Fax: 229-889-1521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number035959
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: