MEDICARE: MIDDLE MOODYCARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	PHRE006040	GA
2	3336C0003X	Community/Retail Pharmacy	PHRE006040	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1111828	OTHER	NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801881545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDDLE MOODYCARE INC

Provider Business Mailing Address
First Line	:	4839 BLOOMFIELD RD
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31206-4307
Country	:	US
Telephone Number	:	478-781-1213
Fax Number	:	478-788-9078

Provider Business Practice Location Address
First Line	:	4839 BLOOMFIELD RD
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31206-4307
Country	:	US
Telephone Number	:	478-781-1213
Fax Number	:	478-788-9078

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. ROBERT BENJAMIN MOODY III
Credential	:	R.PH.
Telephone Number	:	478-781-1213

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	05/20/2025

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Directions to “MIDDLE MOODYCARE INC ” Practice Location

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