Healthcare Provider Details

I. General information

NPI: 1760616775
Provider Name (Legal Business Name): STACIA LYNN MOYER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STACIA HOWARD

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 E 3RD ST
CHATTANOOGA TN
37403-2147
US

IV. Provider business mailing address

1018 DODIE DR
CHATTANOOGA TN
37421-1276
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-7000
  • Fax:
Mailing address:
  • Phone: 352-665-9542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: