Healthcare Provider Details

I. General information

NPI: 1992746853
Provider Name (Legal Business Name): KWELI AYO MOYO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 01/07/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CUMBERLAND PKWY SE BEHAVIORAL HEALTH DEPARTMENT
ATLANTA GA
30339-3915
US

IV. Provider business mailing address

3495 PIEDMONT RD NE TSPMG NINE PIEDMONT CENTER
ATLANTA GA
30305-1717
US

V. Phone/Fax

Practice location:
  • Phone: 404-365-0966
  • Fax:
Mailing address:
  • Phone: 404-364-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number056899
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: