Healthcare Provider Details

I. General information

NPI: 1396477808
Provider Name (Legal Business Name): JOEL TUMALIUAN MOATS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S MADISON ST
THOMASVILLE GA
31792-5473
US

IV. Provider business mailing address

608 N KEVIN CT
STATESBORO GA
30461-2743
US

V. Phone/Fax

Practice location:
  • Phone: 229-236-0831
  • Fax:
Mailing address:
  • Phone: 912-690-0830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP204844
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: