Healthcare Provider Details

I. General information

NPI: 1629255252
Provider Name (Legal Business Name): JASON BELMONT MOYE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 MILULI AVE
BAINBRIDGE GA
39819-5700
US

IV. Provider business mailing address

1501 MILULI AVE
BAINBRIDGE GA
39819-5700
US

V. Phone/Fax

Practice location:
  • Phone: 229-243-3360
  • Fax: 229-246-9945
Mailing address:
  • Phone: 229-243-3360
  • Fax: 229-246-9945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number64420
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: