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General NPI Number Information
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NPI Number | 1477757839
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Entity Type | Individual
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Provider Name | MECHELLE L MOODY MD
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Gender | Female
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 01/11/2010
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Provider Practice Location Address
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Address Line | 4970 HIGHWAY 90
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City | MARIANNA
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State | FL
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Zip | 32446-6802
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Country | US
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Telephone | 850-718-5620
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Fax | 850-718-5670
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Provider Business Mailing Address
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Address Line | 4970 HIGHWAY 90
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City | MARIANNA
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State | FL
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Zip | 32446-6802
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Country | US
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Telephone | 850-718-5620
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Fax | 850-718-5670
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 046890
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License Number State | GA
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