Healthcare Provider Details

I. General information

NPI: 1285844183
Provider Name (Legal Business Name): JOHN S MOODY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 W FRIENDLY AVE
GREENSBORO NC
27403-1109
US

IV. Provider business mailing address

200 QUEENS RD STE 400
CHARLOTTE NC
28204-3264
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-1100
  • Fax:
Mailing address:
  • Phone: 704-765-2578
  • Fax: 704-333-3397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number26535
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number2008-00671
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: