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General NPI Number Information
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NPI Number | 1225751290
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Entity Type | Individual
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Provider Name | DR. CHASE MOODY
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Gender | Male
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Dates
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Enumeration Date | 09/23/2022
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 1544 BASS RD
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City | MACON
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State | GA
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Zip | 31210-7510
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Country | US
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Telephone | 478-471-4494
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Fax |
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Provider Business Mailing Address
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Address Line | 235 PAYNE HILL DR
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City | CLAYTON
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State | GA
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Zip | 30525-4120
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Country | US
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Telephone | 404-374-2860
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 028652
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License Number State | GA
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