Healthcare Provider Details

I. General information

NPI: 1417362211
Provider Name (Legal Business Name): 23D MEDGRP-MOODY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3278 MITCHELL BLVD
MOODY AFB GA
31699-1500
US

IV. Provider business mailing address

23 RD MEDICAL GROUP 3278 MITCHELL BLVD
MOODY AFB GA
31699-1500
US

V. Phone/Fax

Practice location:
  • Phone: 229-257-3221
  • Fax: 229-257-2345
Mailing address:
  • Phone: 229-257-3221
  • Fax: 229-257-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332000000X
TaxonomyMilitary/U.S. Coast Guard Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: HECTOR MORALES
Title or Position: CHIEF DHA PASS
Credential:
Phone: 210-536-6650