Healthcare Provider Details

I. General information

NPI: 1922371707
Provider Name (Legal Business Name): DR. THOMAS CARBERT MOYE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 E OAKLAND AVE
CAMILLA GA
31730-1529
US

IV. Provider business mailing address

98 E OAKLAND AVE
CAMILLA GA
31730-1529
US

V. Phone/Fax

Practice location:
  • Phone: 229-336-2255
  • Fax: 229-336-2257
Mailing address:
  • Phone: 229-336-2255
  • Fax: 229-336-2257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH023319
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: