Healthcare Provider Details

I. General information

NPI: 1124460415
Provider Name (Legal Business Name): NKOSI MOYO LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: NKOSIYABO MOYO LMT

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 HUNTINGTON RD # 198
ATHENS GA
30606-1861
US

IV. Provider business mailing address

485 HUNTINGTON RD # 198
ATHENS GA
30606-1861
US

V. Phone/Fax

Practice location:
  • Phone: 706-255-8822
  • Fax:
Mailing address:
  • Phone: 706-255-8822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT 008444
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: