MEDICARE: KWELI AYO MOYO MD

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	2084P0800X	Psychiatry Physician	056899	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992746853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KWELI AYO MOYO MD

Provider Business Mailing Address
First Line	:	3495 PIEDMONT RD NE
Second Line	:	TSPMG NINE PIEDMONT CENTER
City	:	ATLANTA
State	:	GA
Zip	:	30305-1717
Country	:	US
Telephone Number	:	404-364-7070
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 CUMBERLAND PKWY SE
Second Line	:	BEHAVIORAL HEALTH DEPARTMENT
City	:	ATLANTA
State	:	GA
Zip	:	30339-3915
Country	:	US
Telephone Number	:	404-365-0966
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	01/07/2022

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