Healthcare Provider Details

I. General information

NPI: 1588020135
Provider Name (Legal Business Name): FONDA MOODY FON TRANS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FONDA MOODY FON TRANS

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 HARBOR OAKS CV
OAKLAND TN
38060-6069
US

IV. Provider business mailing address

50 HARBOR OAKS CV
OAKLAND TN
38060-6069
US

V. Phone/Fax

Practice location:
  • Phone: 901-355-4258
  • Fax:
Mailing address:
  • Phone: 901-355-4258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: