Healthcare Provider Details

I. General information

NPI: 1891190997
Provider Name (Legal Business Name): PATRICIA MOODY M.D.,M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 RIDGECREST RD NE
ATLANTA GA
30307-1846
US

IV. Provider business mailing address

564 RIDGECREST RD NE
ATLANTA GA
30307-1846
US

V. Phone/Fax

Practice location:
  • Phone: 404-377-3777
  • Fax:
Mailing address:
  • Phone: 404-377-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number70253
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: