Organization
LYONS FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN MILTON MOODY M.D. (OWNER)
(912) 526-6567
Entity
Organization
Contact information
Practice address
113 MOODY CIR, LYONS, GA 30436-1428
(912) 526-6567
(912) 526-0471
Mailing address
113 MOODY CIR, LYONS, GA 30436-1428
(912) 526-6567
(912) 526-0471
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000478596G
—
GA
01
—
034904
GEORGIA STATE BOARD OF MEDICAL EXAMINERS
GA
Enumeration date
12/27/2007
Last updated
04/23/2009
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