Individual
KIMBERLY MOXLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
300 CHARTER BLVD, MACON, GA 31210-4875
(800) 444-6845
Mailing address
300 CHARTER BLVD, MACON, GA 31210-4875
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP004375
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SLP004375
GA LICENSE
GA
Enumeration date
10/23/2017
Last updated
10/23/2017
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