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General NPI Number Information
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NPI Number | 1194909010
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Entity Type | Organization
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Legal Business Name | LYONS FAMILY PRACTICE
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 04/23/2009
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Provider Practice Location Address
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Address Line | 113 MOODY CIR
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City | LYONS
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State | GA
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Zip | 30436-1428
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Country | US
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Telephone | 912-526-6567
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Fax | 912-526-0471
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Provider Business Mailing Address
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Address Line | 113 MOODY CIR
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City | LYONS
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State | GA
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Zip | 30436-1428
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Country | US
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Telephone | 912-526-6567
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Fax | 912-526-0471
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN MILTON MOODY
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Credential | M.D.
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Telephone | 912-526-6567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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