# CHARLES B MOOMEY JR MD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902003841
- **Authorized official:** CHARLES BRUCE MOOMEY JR. M.D. (OWNER)
- **Authorized official phone:** (770) 962-9977

## Contact information

- **Practice address:** 631 PROFESSIONAL DRIVE, SUITE 300, LAWRENCEVILLE, GA 30046-3371
- **Practice address phone:** (770) 962-9977
- **Practice address fax:** (770) 339-9804
- **Mailing address:** 631 PROFESSIONAL DRIVE, SUITE 300, LAWRENCEVILLE, GA 30046-3371
- **Mailing address phone:** (770) 962-9977
- **Mailing address fax:** (770) 339-9804

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | 049923 | GA | Yes |

## Other

- **Enumeration date:** 07/02/2007
- **Last updated:** 09/01/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00899951A | — | GA |