Healthcare Provider Details

I. General information

NPI: 1912361809
Provider Name (Legal Business Name): LORELI GARNICA MOYA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 COLLIER RD NW STE 775
ATLANTA GA
30309-1608
US

IV. Provider business mailing address

35 COLLIER RD NW STE 775
ATLANTA GA
30309-1608
US

V. Phone/Fax

Practice location:
  • Phone: 404-350-4280
  • Fax: 404-351-8526
Mailing address:
  • Phone: 404-350-4280
  • Fax: 404-351-8526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number82889
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: