Individual
WINFRED DERRICK MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
565 OLD NORCROSS RD, SUITE #200, LAWRENCEVILLE, GA 30046-4308
(770) 962-5040
(770) 962-5056
Mailing address
2295 CAPE COURAGE WAY, SUWANEE, GA 30024-2760
(678) 371-8167
(678) 376-8983
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
045299
GA
207N00000X
Dermatology Physician
Primary
045299
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000821158A
—
GA
Enumeration date
11/16/2005
Last updated
02/16/2012
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