Individual
ASHLEY TUMLIN MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
101 S RAVENEL ST, SUITE 230, FLORENCE, SC 29506-2618
(843) 777-7043
(843) 777-7041
Mailing address
PO BOX 3239, FLORENCE, SC 29502-3239
(843) 777-7120
(843) 777-7102
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
730
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0503PA
—
SC
Enumeration date
12/29/2006
Last updated
02/15/2021
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