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Individual

TONYA MOYD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
351 KINGS BRIDGE RD, MARTINEZ, GA 30907-9616
(706) 339-6749
Mailing address
351 KINGS BRIDGE RD, MARTINEZ, GA 30907-9616
(706) 339-6749
(706) 869-0953

Taxonomy

Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
CLA002026
GA
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
CLA00206
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
146305913A
GA
05
146305913B
GA
Enumeration date
10/16/2013
Last updated
10/16/2013
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