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NPI Code Detail

MEDICARE: DR. TERI NELSON MOAK M.D.

MEDICARE:  DR. TERI NELSON MOAK  M.D.
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
1208200000XPlastic Surgery Physician2015017254MO
2208200000XPlastic Surgery Physician97664GA

General Provider Information

NPI Number : 1821479734
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TERI NELSON MOAK M.D.
Provider Business Mailing Address
First Line : 6045 BARFIELD RD STE 100
Second Line :
City : SANDY SPRINGS
State : GA
Zip : 30328-4402
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6045 BARFIELD RD STE 100
Second Line :
City : SANDY SPRINGS
State : GA
Zip : 30328-4402
Country : US
Telephone Number : 404-250-3333
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2015
Last Update Date : 03/16/2024

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